Medline ® Abstracts for References 8-10

We report a case involving an 81-tear-old man with schizoaffective disorder who presented with neuroleptic malignant syndrome (NMS) after an increase in his neuroleptic dose. NMS, a rare but potentially fatal complication of neuroleptic medications (e.g., antipsychotics, sedatives and antinauseants), is characterized by hyperthermia, muscle rigidity, an elevated creatine kinase level and autonomic instability. The syndrome often develops after a sudden increase in dosage of the neuroleptic medication or in states of dehydration. Treatment is mainly supportive and includes withdrawal of the neuroleptic medication and, possibly, administration of drugs such as dantrolene and bromocriptine. Complications of NMS include acute renal failure and acute respiratory failure. Given the widespread prescription of neuroleptics by physicians in a variety of fields, all physicians need to be able to recognize and appropriately manage NMS.

BACKGROUND: Neuroleptic malignant syndrome (NMS) is a potentially fatal adverse event associated with the use of antipsychotics.

OBJECTIVE: The authors provide information on the development and outcome of NMS during antipsychotic treatment of delirium or agitation in medically ill patients.

METHOD: The authors present case reports and a literature review of NMS arising during antipsychotic treatment of delirium.

RESULTS: A total of 25 cases of NMS occurring in patients with delirium or agitation were identified. Most cases involved men with agitated delirium who received relatively high doses of parenteral haloperidol. The signs and symptoms of NMS episodes were similar to those reported in other settings, and most patients had a complete recovery.

CONCLUSION: Clinicians utilizing antipsychotics in managing delirium or agitation are advised to be vigilant for NMS. Further study is required to determine whether certain patient characteristics or medications present greater risk for this serious adverse event.