Neuroleptic malignant syndrome Flashcards Preview

Psychiatry > Neuroleptic malignant syndrome > Flashcards

Flashcards in Neuroleptic malignant syndrome Deck (11)
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1

Definition

Uncommon, idiosyncratic, life threatening complication of treatment with antipsychotic medications.
Characterised by AMS, muscle rigidity, altered ANS, hyperthermia

2

Is it a reproducible dose dependant relationship

Not dose dependant. Predisposing brain abnormalities (PD, Wilsons), show sensitivity.
Speculation the risk is genetic

3

Key diagnostic features

Presence of risk factors
Altered mental status: confusion, delirium, stupor
Muscle rigidity
Autonomic dysfunction: Tachycardia, labile hypertension, diaphoresis, tachypnoea, urinary incontinence
Hyperthermia
Psychiatric history

4

Strong risk factors

Exposure to antipsychotic medications
Abrupt withdrawal of dopaminergic agents
Structural brain abnormality

5

Weak risk factors

Older age
Pre-existing agitation
Akathsia
Male sex
Iron deficiency
Catatonia
Dehydration

6

Investigations

FBC- elevate
Serum CK _
Metabolic panel- N
Brain CT/MRI- may show structural abnormality
Urine, blood, LP, toxicology screen, CXR->rule out differential, generally normal

7

Important differentials

Sepsis
Drugs
Catatonia
Serotonin toxicity
Mania
Malignant hyperthermia
Heat stroke
Metabolic
Infarction
NPH
Brain tumors

8

Differentiating from Serotonin toxicity

SS will have twitching, shivering, restless vs global rigidity
SS will be flushed, sweaty vs pale
SS will have vomiting, diarrhea vs no GI symptoms

9

Management

1. ABC
2. Withdrawal of antipsychotics/dopamine antagonists must be stopped
3. Dopamine agonists must be restored->bromocriptine
4. Fluids
5. Physical cooling methods for hyperthermia
6. If dysphagia- may require a NGT
7. For agitation Lorazepam 1-4mg
8. Sedation and intubation may be required (diazepam, midazolam)

10

What to do is patients psychiatric symptoms compel resumption of antipsychotic meds

Delay of at least two weeks following resolution of NMS episode advised.

11

Follow up recommendations

Will need CK level monitoring
Tests repeated daily until symptoms and laboratory abnormalities resolve