Neuroleptic malignant syndrome in puerperal women

Year 2024, Volume: 15 Issue: 2, 56 - 58, 28.06.2024

Sadesvaran Muniandy , Asmalia Khalid Mohd Lotfi Hamzah Hafidahwati Hamad@ahmad

https://doi.org/10.33706/jemcr.1420313

Cited By: 1

Abstract

Introduction
Neuroleptic malignant syndrome is an rare event, even more so among patient from puerperal period. The incidence risk is of 0.11%. It is often occurs when a patient is prescribed on antipsychotic for long duration of time.

Case Report
We report a case of a female patient, two weeks in post natal period presented with altered behaviour at home. She has prior admission being treated for post partum psychosis with anti psychotic. However antipschotic was withheld as she developed extrapyramidal symptoms while in ward. At home, she developed fever, altered sensorium and fitting-like-episode. On arrival patient was unresponsive and with features of impaired airway patency. Her had unstable vital sign with elevated blood pressure, heart rate and temperature. Brain imagine came back normal, excluding brain pathology. She was diagnosed as neuroleptic malignant syndrome as fulfilled features of elevated creatine kinase. She was treated symptomatic by providing first aid to reduce temperature and started on benzodiazepines. She was subsequently admitted to intensive ward and responded well to treatment

Conclusion
Physician must be familiar and have high index of suspicious to identify and treat neuroleptic malignant syndrome. Without prompt treatment, it is highly fatal.

Keywords

neuroleptic malignant syndrom, puerperal, anti psychotic, withdrawal

Supporting Institution

Hospital Sultanah Nur Zahirah, Ministry of Health, Malaysia

References

• 1. Sarkar S, Gupta N. Drug information update. Atypical antipsychotics and neuroleptic malignant syndrome: Nuances and pragmatics of the association. BJPsych Bull. 2017;41(4):211–6.
• 2. Lao KSJ, Zhao J, Blais JE, Lam L, Wong ICK, Besag FMC, et al. Antipsychotics and Risk of Neuroleptic Malignant Syndrome: A Population-Based Cohort and Case-Crossover Study. CNS Drugs [Internet]. 2020;34(11):1165–75. Available from: https://doi.org/10.1007/s40263-020-00767-9
• 3. Alexander, Packacheril J; Thomas, Ranji M; Das A. Is Risk of Neuroleptic malignant syndrome increased in the Postpartum period. J Clin Psychiatry. 198AD;52(5):254–5.
• 4. Trollor JN, Chen X, Sachdev PS. Neuroleptic malignant syndrome associated with atypical antipsychotic drugs. CNS Drugs. 2009;23(6):477–92.
• 5. Su YP, Chang CK, Hayes RD, Harrison S, Lee W, Broadbent M, et al. Retrospective chart review on exposure to psychotropic medications associated with neuroleptic malignant syndrome. Acta Psychiatr Scand. 2014;130(1):52–60.
• 6. Belvederi Murri M, Guaglianone A, Bugliani M, Calcagno P, Respino M, Serafini G, et al. Second-Generation Antipsychotics and Neuroleptic Malignant Syndrome: Systematic Review and Case Report Analysis. Drugs R D. 2015;15(1):45–62.
• 7. Wang HY, Li T, Li XL, Zhang XX, Yan ZR, Xu Y. Anti-N-methyl-D-aspartate receptor encephalitis mimics neuroleptic malignant syndrome: Case report and literature review. Neuropsychiatr Dis Treat [Internet]. 2019;15:773–8. Available from: https://doi.org/10.2147/NDT.S195706
• 8. Koksal A, Baybas S, Mutluay B, Altunkaynak Y, Keskek A. A case of NMDAR encephalitis misdiagnosed as postpartum psychosis and neuroleptic malignant syndrome. Neurol Sci. 2015;36(7):1257–8.
• 9. Price DK, Turnbull GJ, Gregory RP, Stevens DG. Neuroleptic Malignant Syndromein a Case of Post-Partum Psychosis. Br J psychiatry. 1989;(155):849–52.
• 10. Ghafour I, Elyasi F. Metoclopramide-induced neuroleptic malignant syndrome: A review study. Iran J Psychiatry Behav Sci. 2020;14(3).
• 11. Amore M, Zazzeri N. Neuroleptic malignant syndrome after venlafaxine. Prog Neuro-Psychopharmacol Biol Psychiat. 1995;8(19):1323–34.
• 12. Stefanowski BW, Antosik-Wójcinska AZ, Jeschke J, Dominiak M, Święcicki Ł. Postpartum psychosis – case report on effective treatment of electroconvulsive therapy in a patient with a history of neuroleptic malignant syndrome. Pharmacother Psychiatry Neurol. 2019;35(1):75–80.
• 13. KV J, Gudimetla S, Sripada R, Simon A, Raja Y. A review on Neuroleptic Malignant Syndrome and Its Treatment Strategy: For Clinicians. World J Curr Med Pharm Res. 2019;1(1).
• 14. Rogers JP, Oldham MA, Fricchione G, Northoff G, Wilson JE, Mann SC, et al. Evidence-based consensus guidelines for the management of catatonia : Recommendations from the British Association for Psychopharmacology. 2023.