Nöroleptik Malign Sendromda Atipik Antipsikotiklerin Rolü: İki Olgu Sunumu Ve Literatürün Gözden Geçirilmesi

Öz

Introduction: Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal reaction to an antipsychotic drug. The main features of NMS are muscle rigidity and hyperthermia that may be accompanied by other extrapyramidal effects, autonomic instability, and mental status changes. NMS is thought to occur more frequently with typical antipsychotics than with atypical or low-potency antipsychotics.   Case Report: Two cases with NMS were reported in this manuscript, which were previously treated with quetiapine and clozapine regimens for schizophrenia and acute psychosis. Both of the cases had prominent fever and muscular rigidity. One of the patients presented with syncope to the emergency department; the other patient had significant alterations in mental status. Differential diagnosis with other infectious and neurological diseases, including stroke and meningitis, was conducted. Both of the cases survived with standard supportive care, and none of them required dantrolene.   Conclusion: Due to the widespread use of atypical agents in treatment regimens, the syndrome tends to occur with atypical antipsychotic drugs much more often.

Anahtar Kelimeler

• Nöroleptik malign sendrom, bilinç değişikliği, acil servis

The Role of Atypical Antipsychotics in Neuroleptic Malignant Syndrome: Report of Two Cases and

Öz

Introduction: Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal reaction to an antipsychotic drug. The main features of NMS are muscle rigidity and hyperthermia that may be accompanied by other extrapyramidal effects, autonomic instability, and mental status changes. NMS is thought to occur more frequently with typical antipsychotics than with atypical or low-potency antipsychotics. Case Report: Two cases with NMS were reported in this manuscript, which were previously treated with quetiapine and clozapine regimens for schizophrenia and acute psychosis. Both of the cases had prominent fever and muscular rigidity. One of the patients presented with syncope to the emergency department; the other patient had significant alterations in mental status. Differential diagnosis with other infectious and neurological diseases, including stroke and meningitis, was conducted. Both of the cases survived with standard supportive care, and none of them required dantrolene. Conclusion: Due to the widespread use of atypical agents in treatment regimens, the syndrome tends to occur with atypical antipsychotic drugs much more often

Anahtar Kelimeler

• Neuroleptic malignant syndrome, altered mental status, emergency department

Kaynakça

1. Paul M, Michael SG, John S, Lenox RJ. An atypical presentation of neuroleptic malignant syndrome: diagnostic dilemma in a critical care setting. Respir Care 2012; 57: 315-7.
2. Ergin M, Cander B, Girişgin AS, Koçak S, Acar T, Gül M. A serious side effect of antipsychotic therapy: Neuroleptic malign syndrome. JAEMCR 2012; 3: 83-5. [CrossRef]
3. Detweiler MB, Sullivan K, Sharma TR, Kim KY, Detweiler JG. Case reports of neuroleptic malignant syndrome in context of quetiapine use. Psychiatr Q 2013; doi: 10.1007/s11126-013-9264-4 [CrossRef]
4. Gillman PK. Neuroleptic malignant syndrome: Mechanisms, interactions, and causality. Mov Disord 2010; 25: 1780-90. [CrossRef]
5. Gortney JS, Fagan A, Kissack JC. Neuroleptic malignant syndrome secondary to quetiapine. Ann Pharmacother 2009; 43: 785-91. [CrossRef]
6. Caroff SN. The neuroleptic malignant syndrome. J Clin Psychiatry 1980; 41: 79-83.
7. Carroll BT, Surber SA. The problem of atypical neuroleptic malignant syndrome: a case report. Psychiatry (Edgmont) 2009; 6: 45-7.
8. Caroff SN, Mann SC. Neuroleptic malignant syndrome. Med Clin North Am 1993; 77: 185-202.

9. Levenson JL. Neuroleptic malignant syndrome. Am J Psychiatry 1985; 142: 1137-45.
10. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4. baskı. Washington DC, American Psychiatric Association, 2000, s. 795-8.