Antipsikotik İlaçların Ciddi Bir Yan Etkisi: Nöroleptik Malign Sendrom

Abstract

Nöroleptik Malign Sendrom (NMS) dopamin reseptör antagonistleri ile tedavinin nadir, idiosenkratik, potansiyel olarak hayatı tehdit edici bir komplikasyonudur. NMS ateş, ciddi kas rijiditesi ve otonomik ve mental durum değişiklikleri karakterizedir. Bu yazıda Ocak 2010 ve Nisan 2011 tarihleri arasında acil servisimize başvurmuş ve NMS tanısı almış 3 olgu sunulmaktadır. NMS akut başlangıç, hipertermi, belirgin mental değişiklik, artmış motor aktivite ve otonomik semptomlar ile ortaya çıkar. Agresif ve zamanında yapılan girişimler fatal sonuç potansiyeli açısından çok önemlidir. Kullanılan ajanın hemen kesilmesini takiben destekleyici tedavi çoğu olguda tercih edilen tedavi seçeneğidir. Destek tedavi, intravenöz sıvılar ile hidrasyonun sağlanması ve irritasyon için benzodiazepinlerin kullanımını içerir.

Keywords

• Antipsikotikler, yan etki, nöroleptik malign sendrom

A Serious Side Effect of Antipsychotic Therapy: Neuroleptic Malign Syndrome

Abstract

Neuroleptic malign syndrome (NMS) is a rare, idiosyncratic, potentially life-threatening complication of treatment with dopamine receptor antagonists. NMS is characterized by fever, severe muscle rigidity and autonomic and mental status changes. Here, we present three NMS cases admitted to our emergency service between January 2010 and April 2011. NMS has the characteristics of acute onset, hyperthermia, profound mental changes, heightened motor activity and autonomic symptoms. Aggressive and timely intervention is crucial due to the potential for fatal outcomes. Immediate withdrawal of the offending agent followed by supportive care is the treatment of choice for most patients. Supportive care includes the infusion of intravenous fluids for hydration and treatment with benzodiazepines to manage irritation

Keywords

• Antipsychotics, adverse effect, neuroleptic malign syndrome

References

1. Strawn JR, Keck PE, Caroff SN. Neuroleptic malignant syndrome. Am J Psychiatry 2007; 164: 870-6. [CrossRef]
2. Cvjetkovic-Bosnjak M, Sodatovic-Stajic B. Side effects of antipschycotic agents- neuroleptic malignant syndrome. Med Pregl 2010; 63: 705-8. [CrossRef]
3. Steele D, Keltner NL, McGuiness TM. Are neuroleptic malignant syndro- me and serotonin syndrome the same syndrome? Perspect Psychiatr Care 2010; 47: 58-62. [CrossRef]
4. Sato Y, Asoh T, Metoki N, Satoh K. Efficiancy of methylprednisolone pul- se therapy on neuroleptic malignant syndrome in Parkinson’s disease. J Neurol Neurosurg Psychiatry 2003; 74: 574-6. [CrossRef]
5. Man SP. An uncommon adverse efect of levodopa withdrawal in a patient taking antipsychotic medication: neuroleptic malignant-like syndrome. Hong Kong Med J 2011; 17: 74-6.
6. Pereira YD, Srivastava A, Cuncoliencar BS, Naik N. Resolution of symptoms in neuroleptic malignant syndrome. Indian J Psychiatry 2010; 52: 264-6. [CrossRef]
7. Levenson J. Neuroleptic malign syndrome. Am J Pscyhiatry 1985; 142: 1137-45.
8. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed, text revision. Washington DC, American Psychiatric Association, 2000, pp. 795-8.