Neuroleptic Malignant Syndrome
Antipsychotic Agents
Dantrolene
Mutism
Haloperidol
Isocarboxazid
Chlorpromazine
Catatonia
Amoxapine
Bromocriptine
Repeated propofol anesthesia for a patient with a history of neuroleptic malignant syndrome. (1/65)
Neuroleptic malignant syndrome (NMS) is the most serious side effect produced by the administration of antipsychotic drugs. NMS shares many clinical similarities with malignant hyperthermia (MH), but the etiology of NMS and the relation between NMS and MH remain unknown. Anesthetic regimens for patients with NMS are not well established. We gave repeated anesthesia to a patient with a history of NMS undergoing electroconvulsive therapy for the treatment of depression. Propofol and vecuronium were used in twelve consecutive ECT sessions without complications. In this case report, we describe the safe and satisfactory repeated use of propofol in a patient with a history of NMS, and outline NMS and its questionable relation to MH. (+info)Selective destruction of nigrostriatal dopaminergic neurons does not alter [3H]-ryanodine binding in rat striatum. (2/65)
Dopamine nigrostriatal neurons are important for motor control and may contain a particularly dense population of ryanodine receptors involved in the control of dopamine release. To test this hypothesis, we used a classical model of unilateral selective lesion of these neurons in rats based on 6-hydroxydopamine (6-OHDA) injection into the substantia nigra. Binding of [3H]-GBR 12935, used as a presynaptic marker since it labels specifically the dopamine uptake complex, was dramatically decreased by 83-100% in striatum homogenates after 6-OHDA lesion. On the contrary, no reduction of [3H]-ryanodine binding was observed. The present data indicate that [3H]-ryanodine binding sites present in rat striatum are not preferentially localized in dopaminergic terminals. (+info)Muscle changes in the neuroleptic malignant syndrome. (3/65)
AIMS: To characterise the skeletal muscle changes in the neuroleptic malignant syndrome (NMS). METHODS: Detailed light and ultrastructural examination was carried out on skeletal muscle from three cases of NMS, two associated with recreational drugs (3,4-methlenedioxymethylamphetamine (MDMA, Ecstasy) and lysergic acid diethylamide (LSD)) and one with antipsychotic drugs (fluoxetine (Prozac) and remoxipride hydrochloride monohydrate (Roxiam)). RESULTS: The muscles were grossly swollen and oedematous in all cases, in one with such severe local involvement that the diagnosis of sarcoma was considered. On microscopy, there was conspicuous oedema. In some fascicles less than 10% of fibres were affected whereas in others more than 50% were pale and enlarged. There was a spectrum of changes: tiny to large vacuoles replaced most of the sarcoplasm and were associated with necrosis. A striking feature in some fibres was the presence of contraction bands separating segments of oedematous myofibrils. Severe endomysial oedema was also detectable. There was a scanty mononuclear infiltrate but no evidence of regeneration. CONCLUSIONS: The muscle changes associated with NMS are characteristic and may be helpful in differential diagnosis. (+info)Methyl p-hydroxybenzoate (E-218) a preservative for drugs and food is an activator of the ryanodine receptor Ca(2+) release channel. (4/65)
1. Haloperidol is a drug used in the management of several psychotic disorders and its use has been linked to Neuroleptic Malignant Syndrome. In the present study we have investigated the effect of a commercial preparation of haloperidol, Serenase, on skeletal muscle sarcoplasmic reticulum. 2. Addition of Serenase to isolated terminal cisternae caused a rapid release of calcium. We tested whether the active Ca(2+)-releasing substance was haloperidol or another compound present in the preparation. 3. Our results show that methyl p-hydroxybenzoate, one of the preservatives and a commonly used anti-microbial agent (E-218) is an activator of Ca(2+) release (E.C. 50=2.0 mM), mediated by a ruthenium red-sensitive Ca(2+) release channel present in skeletal muscle terminal cisternae. (+info)Neuroleptic malignant syndrome induced by droperidol. (5/65)
A case of droperidol-induced neuroleptic malignant syndrome during anaesthesia is presented. An 86-year-old man underwent spinal anaesthesia for open reduction and internal fixation of a trochanteric hip fracture. He received droperidol 5 mg intravenously for sedation towards the end of surgery. He subsequently became very drowsy and experienced marked muscle rigidity and autonomic instability. He became febrile postoperatively. The clinical syndrome resolved after 12 hours. When using droperidol in anaesthesia or intensive care--especially when large doses are given--the development of neuroleptic malignant syndrome should be suspected if the patient becomes febrile and has muscle rigidity and autonomic instability. (+info)Biochemical alterations during medication withdrawal in Parkinson's disease with and without neuroleptic malignant-like syndrome. (6/65)
The object was to assess alterations in CSF concentrations of monoamine metabolites during withdrawal of medication in patients with Parkinson's disease in relation to the presence or absence of episodes resembling neuroleptic malignant syndrome (NMS). This syndrome is a fatal condition developing after neuroleptic therapy, and a neuroleptic malignant-like syndrome (NMLS) may also occur after withdrawal of antiparkinsonian drugs in patients with Parkinson's disease. Previous biochemical assays showed that the CSF concentration of the dopamine metabolite homovanillic acid (HVA) is an independent prognostic factor for development of NMLS in patients with Parkinson's disease. In the present study, CSF concentrations of HVA, the noradrenaline (norepinephrine) metabolite 3-methoxy-4-hydroxyphenylethylene glycol, and the serotonin metabolite 5-hydroxyindole acetic acid were assayed using high performance liquid chromatography with electrochemical detection. The study population consisted of nine patients with Parkinson's disease with NMLS and 12 without NMLS, in whom metabolites were assayed during both withdrawal and remedicated periods. Concentrations of HVA in the CSF were significantly lower during the withdrawal period than the medicated period regardless of whether patients developed NMLS, and HVA concentrations were comparably increased after remedication in both groups. However, HVA concentrations were significantly lower in patients with NMLS than in those without NMLS during both withdrawal and medicated periods. Other metabolites showed no significant differences. The present data provide further biochemical evidence for extremely suppressed central dopaminergic activity during NMLS, which may indicate a narrow safety margin for medication withdrawal in patients with Parkinson's disease. (+info)Three patients with isolated adrenocorticotropin deficiency presenting with neuroleptic malignant syndrome-like symptoms. (7/65)
We report 3 patients with isolated adrenocorticotropin (ACTH) deficiency presenting with neuroleptic malignant syndrome (NMS)-like symptoms. All patients were in their 60's or 70's and showed consciousness disturbance, a high-grade fever, extrapyramydal signs, and muscle enzyme elevations, which met the criteria for NMS. Also, they all showed hyponatremia induced by isolated ACTH deficiency. In addition to the standard therapy for NMS, corticosteroid supplement therapy was effective in all patients. There thus appear to be subjects with isolated ACTH deficiency among patients presenting with NMS-like symptoms, and adrenal and pituitary function should be checked in NMS patients with hyponatremia. (+info)Neuroleptic malignant syndrome presenting as pulmonary edema and severe bronchorrhea. (8/65)
Neuroleptic malignant syndrome is a rare (incidence, 0.02%-3.2%) but dangerous complication following the use of neuroleptic drugs. When not promptly recognized, this disease carries a high mortality (10%-20%) and morbidity rate. We report an unusual case of neuroleptic malignant syndrome that presented predominantly with autonomic instability in the form of recurrent episodes of respiratory distress. The respiratory distress was initially caused by pulmonary edema and later was caused by severe bronchorrhea. We propose that aspiration pneumonia resulting in respiratory failure, the leading cause of death in neuroleptic malignant syndrome, may be a result of a combination of altered mental status and bronchorrhea. This has therapeutic implications because early institution of bromocriptine/dantrolene can prevent aspiration pneumonia and, hence, mortality from respiratory failure. (+info)Neuroleptic Malignant Syndrome (NMS) is a rare but potentially life-threatening condition characterized by a group of symptoms that may occur together in individuals taking antipsychotic medications, or in some cases, after the abrupt discontinuation of dopamine agonists.
The four primary features of NMS are:
1. High fever (temperature greater than 38°C/100.4°F)
2. Muscle rigidity or stiffness
3. Altered mental status, which can range from confusion and agitation to a coma
4. Autonomic instability, which can cause symptoms such as irregular pulse or blood pressure, rapid heartbeat, sweating, and unstable body temperature.
Other possible symptoms of NMS may include:
- Tremors or involuntary movements (dyskinesias)
- Labored breathing (dyspnea)
- Changes in heart rate and rhythm (arrhythmias)
- Elevated white blood cell count (leukocytosis)
- Metabolic abnormalities, such as increased creatine phosphokinase levels, elevated liver enzymes, and myoglobinuria.
NMS is a medical emergency that requires immediate treatment, typically involving the discontinuation of the offending medication, supportive care (such as hydration, temperature control, and management of autonomic instability), and sometimes medications to reduce muscle rigidity and lower fever. The exact cause of NMS remains unclear, but it is thought to be related to a dysregulation in dopamine receptors in the brain.
Antipsychotic agents are a class of medications used to manage and treat psychosis, which includes symptoms such as delusions, hallucinations, paranoia, disordered thought processes, and agitated behavior. These drugs work by blocking the action of dopamine, a neurotransmitter in the brain that is believed to play a role in the development of psychotic symptoms. Antipsychotics can be broadly divided into two categories: first-generation antipsychotics (also known as typical antipsychotics) and second-generation antipsychotics (also known as atypical antipsychotics).
First-generation antipsychotics, such as chlorpromazine, haloperidol, and fluphenazine, were developed in the 1950s and have been widely used for several decades. They are generally effective in reducing positive symptoms of psychosis (such as hallucinations and delusions) but can cause significant side effects, including extrapyramidal symptoms (EPS), such as rigidity, tremors, and involuntary movements, as well as weight gain, sedation, and orthostatic hypotension.
Second-generation antipsychotics, such as clozapine, risperidone, olanzapine, quetiapine, and aripiprazole, were developed more recently and are considered to have a more favorable side effect profile than first-generation antipsychotics. They are generally effective in reducing both positive and negative symptoms of psychosis (such as apathy, anhedonia, and social withdrawal) and cause fewer EPS. However, they can still cause significant weight gain, metabolic disturbances, and sedation.
Antipsychotic agents are used to treat various psychiatric disorders, including schizophrenia, bipolar disorder, major depressive disorder with psychotic features, delusional disorder, and other conditions that involve psychosis or agitation. They can be administered orally, intramuscularly, or via long-acting injectable formulations. The choice of antipsychotic agent depends on the individual patient's needs, preferences, and response to treatment, as well as the potential for side effects. Regular monitoring of patients taking antipsychotics is essential to ensure their safety and effectiveness.
Dantrolene is a muscle relaxant that is used to treat or prevent muscle spasms and stiffness caused by various medical conditions, such as spinal cord injuries, stroke, cerebral palsy, multiple sclerosis, and certain types of poisoning. It works by reducing the sensitivity of the muscles to nerve impulses, which helps to relieve muscle spasms and reduce muscle tone.
Dantrolene is available in oral capsule and injectable forms. The oral form is typically used for long-term management of muscle spasticity, while the injectable form is used as an emergency treatment for a life-threatening condition called malignant hyperthermia, which can occur as a complication of general anesthesia in susceptible individuals.
It's important to note that dantrolene can have side effects, including drowsiness, dizziness, weakness, and diarrhea. It should be used with caution and under the supervision of a healthcare provider, especially when used in combination with other medications or in patients with certain medical conditions.
1. Mutism (also known as Selective Mutism) is a psychological disorder where a person becomes unable to speak in specific situations or around certain people, despite having normal language skills. It's most commonly diagnosed in children and can lead to significant distress and impairment in social communication and academic performance. The exact cause of mutism isn't well understood, but it's believed to be related to anxiety and social phobias.
2. In a medical context, Mutism may also refer to a symptom characterized by the loss of speech due to neurological or psychological conditions, such as after a stroke or head injury, or in response to severe emotional trauma. This is different from Selective Mutism, which is a specific anxiety disorder that occurs in certain situations and not others.
Loxapine is an antipsychotic medication that is primarily used to treat schizophrenia. It belongs to a class of drugs called tricyclic antipsychotics, which work by blocking dopamine receptors in the brain. Loxapine can help reduce the symptoms of schizophrenia such as hallucinations, delusions, and disordered thinking. In addition to its use in treating schizophrenia, loxapine may also be used off-label for the treatment of agitation and aggression in individuals with dementia or other mental health disorders.
It is important to note that loxapine can have serious side effects, including neurological symptoms such as tremors, stiffness, and uncontrolled muscle movements, as well as cardiovascular symptoms such as low blood pressure and abnormal heart rhythms. Therefore, it should only be prescribed by a healthcare professional who is experienced in managing the use of antipsychotic medications.
Haloperidol is an antipsychotic medication, which is primarily used to treat schizophrenia and symptoms of psychosis, such as delusions, hallucinations, paranoia, or disordered thought. It may also be used to manage Tourette's disorder, tics, agitation, aggression, and hyperactivity in children with developmental disorders.
Haloperidol works by blocking the action of dopamine, a neurotransmitter in the brain, which helps to regulate mood and behavior. It is available in various forms, including tablets, liquid, and injectable solutions. The medication can cause side effects such as drowsiness, restlessness, muscle stiffness, and uncontrolled movements. In rare cases, it may also lead to more serious neurological side effects.
As with any medication, haloperidol should be taken under the supervision of a healthcare provider, who will consider the individual's medical history, current medications, and other factors before prescribing it.
Isocarboxazid is a type of medication known as a monoamine oxidase inhibitor (MAOI), which is primarily used in the treatment of depression. It works by blocking the action of monoamine oxidase, an enzyme that breaks down certain neurotransmitters (chemical messengers) in the brain such as serotonin, dopamine, and norepinephrine. By inhibiting this enzyme, Isocarboxazid helps to increase the levels of these neurotransmitters in the brain, which can help to improve mood and alleviate symptoms of depression.
It is important to note that MAOIs like Isocarboxazid have significant potential for serious side effects and drug interactions, and their use must be carefully monitored by a healthcare provider. Patients taking Isocarboxazid must follow strict dietary restrictions and avoid certain medications and foods that can interact with the drug and cause dangerous elevations in blood pressure or other adverse reactions.
Chlorpromazine is a type of antipsychotic medication, also known as a phenothiazine. It works by blocking dopamine receptors in the brain, which helps to reduce the symptoms of psychosis such as hallucinations, delusions, and disordered thinking. Chlorpromazine is used to treat various mental health conditions including schizophrenia, bipolar disorder, and severe behavioral problems in children. It may also be used for the short-term management of severe anxiety or agitation, and to control nausea and vomiting.
Like all medications, chlorpromazine can have side effects, which can include drowsiness, dry mouth, blurred vision, constipation, weight gain, and sexual dysfunction. More serious side effects may include neurological symptoms such as tremors, rigidity, or abnormal movements, as well as cardiovascular problems such as low blood pressure or irregular heart rhythms. It is important for patients to be monitored closely by their healthcare provider while taking chlorpromazine, and to report any unusual symptoms or side effects promptly.
Catatonia is a state of neurogenic motor immobility and behavioral abnormality manifested by stupor, mutism, negativism, rigidity, posturing, stereotypy, agitation, or Grimmacing. It can be a symptom associated with various neurological and mental disorders, such as schizophrenia, bipolar disorder, depression, or brain injury. Catatonic symptoms can also occur as a side effect of certain medications.
The diagnosis of catatonia is typically made based on the observation of characteristic clinical symptoms and the exclusion of other potential causes through medical evaluation. Treatment for catatonia may include medication, such as benzodiazepines or electroconvulsive therapy (ECT), depending on the underlying cause and severity of the symptoms.
Amoxapine is a tricyclic antidepressant (TCA) medication that is primarily used to treat depression. It works by increasing the levels of certain neurotransmitters, such as serotonin and norepinephrine, in the brain. These neurotransmitters are known to play a role in mood regulation, and imbalances in their levels have been linked to depression.
Amoxapine is available in tablet form and is typically taken two or three times a day. It may take several weeks of treatment before the full benefits of amoxapine are felt. Common side effects of amoxapine include dry mouth, blurred vision, constipation, and dizziness.
Like other TCAs, amoxapine carries a risk of serious side effects, including an increased risk of suicide in some patients. It should be used with caution in patients with a history of heart disease or seizures, as it can lower the seizure threshold and increase the risk of cardiac arrhythmias.
It's important to note that amoxapine is not recommended for use in children or adolescents, and it should be used during pregnancy only if the potential benefits outweigh the risks. It's also important to follow the dosage instructions carefully and to inform your healthcare provider of any other medications you are taking, as well as any medical conditions you may have, before starting treatment with amoxapine.
Bromocriptine is a dopamine receptor agonist drug, which means it works by binding to and activating dopamine receptors in the brain. It has several therapeutic uses, including:
* Treatment of Parkinson's disease: Bromocriptine can be used alone or in combination with levodopa to help manage the symptoms of Parkinson's disease, such as stiffness, tremors, spasms, and poor muscle control.
* Suppression of lactation: Bromocriptine can be used to suppress milk production in women who are not breastfeeding or who have stopped breastfeeding but still have high levels of prolactin, a hormone that stimulates milk production.
* Treatment of pituitary tumors: Bromocriptine can be used to shrink certain types of pituitary tumors, such as prolactinomas, which are tumors that secrete excessive amounts of prolactin.
* Management of acromegaly: Bromocriptine can be used to manage the symptoms of acromegaly, a rare hormonal disorder characterized by abnormal growth and enlargement of body tissues, by reducing the production of growth hormone.
Bromocriptine is available in immediate-release and long-acting formulations, and it is usually taken orally. Common side effects of bromocriptine include nausea, dizziness, lightheadedness, and drowsiness. Serious side effects are rare but can include hallucinations, confusion, and priapism (prolonged erection).
Electroconvulsive therapy (ECT) is a medical treatment most commonly used in cases of severe or treatment-resistant major depression, bipolar disorder, and catatonia. In ECT, a brief electrical current is passed through the brain, intentionally triggering a seizure. The purpose and specific effects of this procedure are not fully understood, but it's believed to cause changes in brain chemistry that can help relieve symptoms of certain mental health conditions.
The treatment is typically administered under general anesthesia and is usually given two to three times a week for a total of six to twelve treatments. While ECT has been associated with certain risks, such as memory loss and confusion, it is generally considered safe when performed by trained medical professionals. It's important to note that ECT should only be used in cases where other treatment options have been exhausted or have proven ineffective.
Neuroleptic malignant syndrome
