ABSTRACT
ABSTRACT Neuroleptic malignant syndrome (NMS) is a neurologic emergency potentially fatal. This rare side effect is most commonly associated with first-generation antipsychotics and less frequently with atypical or second-generation antipsychotics. The diagnosis relies on both clinical and laboratory criteria, with other organic and psychiatric conditions being ruled out. CASE REPORT: A 39-year-old female patient, who is institutionalized and completely dependent, has a medical history of recurrent urinary infections and colonization by carbapenem-resistant Klebsiella pneumoniae. Her regular medication regimen included sertraline, valproic acid, quetiapine, risperidone, lorazepam, diazepam, haloperidol, baclofen, and fentanyl. The patient began experiencing dyspnea. Upon physical examination, she exhibited hypotension and a diminished vesicular murmur at the right base during pulmonary auscultation. Initially, after hospitalization, she developed high febrile peaks associated with hemodynamic instability, prompting the initiation of antibiotic treatment. Despite this, her fever persisted without an increase in blood inflammatory parameters, and she developed purulent sputum, necessitating antibiotherapy escalation. The seventh day of hospitalization showed no improvement in symptoms, suggesting NNMS as a differential diagnosis. All antipsychotic and sedative drugs, as well as antibiotherapy, were discontinued, after which the patient showed significant clinical improvement. CONCLUSION: Antipsychotic agents are commonly employed to manage behavioral changes linked to various disorders. However, their severe side effects necessitate a high degree of vigilance, the cessation of all medications, and the implementation of supportive care measures. A prompt and accurate diagnosis of NMS is crucial to alleviating the severe, prolonged morbidity and potential mortality associated with this syndrome.
ABSTRACT
La acatisia es uno de los eventos adversos inducidos por antipsicóticos más prevalentes y puede generar severa angustia en quien lo experimente. Se caracteriza por inquietud psicomotora objetiva y subjetiva. Pertenece al gran paraguas de los "síntomas extrapiramidales", sin embargo, tiene sus particularidades clínicas lo que representa un desafío clínico, tanto en su diagnóstico como en su manejo específico. La presente revisión sintetiza la información disponible a la fecha y ofrece al clínico recomendaciones para prevenir, reconocer y manejar esta complicación frecuente de una de las familias de psicofármacos de mayor prescripción clínica en la actualidad.
Abstract. Akathisia is one of the most prevalent antipsychotic-induced adverse events and causes severe distress in those who experience it. It is characterized by objective and subjective psychomotor restlessness. Usually classified under the great umbrella of extrapyramidal symptoms; however, it has its own clinical peculiarities, which might represent a challenge for the clinician in diagnosis as well as specific management. This review synthesizes the information available to date on antipsychotic-induced akathisia and offers the clinician recommendations to prevent, recognize and treat this prevalent complication of one of the most widely prescribed psychotropic medications today.
Subject(s)
Humans , Antipsychotic Agents/adverse effects , Akathisia, Drug-Induced/therapy , Practice GuidelineABSTRACT
OBJECTIVE：To provide reference for individualized treatment of patients with Neuroleptics-induced malignant syndrome（NMS）. METHODS ：A patient with NMS related to antipsychotics was admitted to our hospital in Sept. 19th 2018. Clinical pharmacists provided pharmaceutical care throughout the whole process ，and put forward suggestions for medication. Through literature review ，clinical pharmacists summarized the clinical manifestations ，risk factors ，pathogenesis，diagnosis and therapeutic drugs of NMS. RESULTS & CONCLUSIONS ：Based on the history of antipsychotic drug use ，the characteristic clinical manifestations of NMS and laboratory examination ，the clinical pharmacist proposed that the patient suffered from antipsychotic drug-related NMS ，and the doctor adopted the suggestions. In the course of treatment ，the clinical pharmacist suggested that the subhibernating mixture should be stopped ；Bromocriptine mesylate tablets should be used in combination with continuous hypothermia instrument for physical cooling ，and the treatment course should be at least 10 days according to drug use before admission and medication plan after admission. The doctor adopted the suggestion. The symptoms began to relieve on the third day ，and the symptoms basically disappeared on the 10th day ，then the patient was discharged on the 13th day. The clinical manifestations of NMS were high fever ，myotonia，mental state change ，autonomic nervous disorder ，creatine phosphokinase and leukocyte increase etc. ；risk factors included drug factors ，demographic factors ，genetic and etc. ；the pathogenesis may be associated with dopaminergic receptor block and musculoskeletal fiber toxicity ；the identification diagnosis was based on clinical manifestation，including the onset time ，neuromuscalar reactivity ，remission time ，etc.；the commonly used drugs were bromocriptine mesylate and dantraline.
ABSTRACT
El desarrollo de los antipsicóticos "atÃpicos" o "de segunda generación" despertó grandes expectativas a partir de la década de 1990, al atribuÃrseles mayor eficacia y tolerabilidad que los antipsicóticos "tÃpicos", "clásicos" o "de primera generación", merced al impacto de una enorme campaña publicitaria por parte de la industria farmacéutica. Sin embargo, diferentes estudios no han podido demostrar en forma fehaciente la pretendida superioridad de aquel grupo de medicamentos en términos de eficacia, prevención de recaÃdas o producción de efectos adversos. Por otro lado, la clasificación de antipsicóticos "clásicos" y "atÃpicos" tampoco se puede sustentar en base a estructura quÃmica, mecanismos de acción, costos o antigûedad, dada la heterogeneidad que exhiben ambos grupos. Por tales motivos, se plantea que la dicotomÃa existente deberÃa descartarse.
The development of "atypical" or "second generation" antipsychotics, generated great expectations from the 1990s, as they were attributed more efficacy and tolerability than the "typical", "classic" or "first generation" antipsychotics, due mostly to the impact of a huge advertising campaign by the pharmaceutical industry. However, different studies have not been able to prove, in a categorical way, the alleged superiority of that group of drugs in terms of efficacy, prevention of relapses or production of adverse effects. On the other hand, the classification of "classic" and "atypical" antipsychotics cannot be supported either by factors such as chemical structure, mechanisms of action, costs or years in the market, , given the heterogeneity that both groups exhibit. For such reasons, it is suggested that the existing dichotomy should be ruled out.
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BACKGROUND@#A reliable and socially validated definition of recovery in schizophrenia is essential to decrease stigma associated with the illness. This study aimed to define recovery in schizophrenia in the Philippine context, determine its specific elements, and describe methods of assessment in clinical practice.@*METHODS@#We invited a group of purposively selected Filipino psychiatrists to participate in six simultaneous roundtable discussions to gather their opinions and perspectives on recovery in schizophrenia. Transcripts of the discussions were then subjected to framework analysis.@*RESULTS AND CONCLUSION@#Most Filipino psychiatrists were of the considered opinion that recovery in schizophrenia is possible, and their vision of a recovered patient resembles a combination of psychological and medical models. The mini-FROGS tool was deemed generally applicable in the Philippine setting except for self-esteem and sense of independence primarily because it is difficult to evaluate. The SWN was received with mixed reactions among the psychiatrists. Spirituality as an element of recovery and the family-oriented culture of the Filipinos were emphasized as important considerations in assessing patients. Other suggestions were given to tailor-fit these tools to the Philippine context.
Subject(s)
Schizophrenia , PhilippinesABSTRACT
No abstract available.
Subject(s)
Humans , Antipsychotic Agents , Dystonia , HIV , HIV Infections , SchizophreniaABSTRACT
La psicosis inducida por corticoides es una entidad clínica muy poco frecuente dentro de la práctica psiquiátrica infanto-juvenil. Presentamos el caso de un adolescente de 14 años que recibió terapia corticoidal intramuscular, endovenosa y oral para tratar un cuadro alérgico, que debuta posteriormente con un episodio psicótico a los pocos días de haber finalizado dicho tratamiento. Se muestrla presentación clínica, el enfrentamiento diagnóstico-terapéutico inicial, el manejo de especialidad y el seguimiento posterior.
The Corticosteroid induced psychosis is a rare clinical entity within the child and adolescent psychiatric practice. We report a case of a 14 years adolescent that received intramuscular, intravenous and oral corticosteroid therapy to treat an allergy, who debuts later with a psychotic episode a few days after finishing such treatment. It is shown the clinical presentation, the initial diagnostic and therapeutic confrontation, the specialist management and the follow up.
Subject(s)
Humans , Male , Adolescent , Adrenal Cortex Hormones/adverse effects , Psychoses, Substance-Induced/diagnosis , Psychoses, Substance-Induced/drug therapy , Anti-Allergic Agents/adverse effects , Antipsychotic Agents/therapeutic use , Benzodiazepines/therapeutic use , Treatment OutcomeABSTRACT
Neuroleptic malignant syndrome (NMS) is a fatal complication most often caused by an adverse reaction to neuroleptic or antipsychotic drugs, and is mostly brought out in the initial stage of medication. Late onset NMS after long term intake of neuroleptics is uncommon, and the neurochemical mechanism is undiscovered. We report a patient of late onset NMS after a long term intake of haloperidol who was successfully treated with dantrolene and bromocriptine.
Subject(s)
Humans , Antipsychotic Agents , Bromocriptine , Dantrolene , Haloperidol , Neuroleptic Malignant SyndromeABSTRACT
Abnormal levels of amino acids have been reported in patients with schizophrenia and have also been investigated as a biomarker to monitor antipsychotic treatment, however results have been inconsistent. The purpose of the present review is to summarize the evidence in the literature of whether amino acid levels can be a biomarker and predict the treatment outcome in schizophrenia. The current review does not support amino acid concentration as a useful biomarker for monitoring antipsychotic response in patients with schizophrenia, although there is evidence that high levels of serum homocysteine and glutamate might be considered as a trait marker for schizophrenia. This review has also highlighted a considerable dearth of studies, specifically of studies evaluating antipsychotic side-effects.
Subject(s)
Humans , Amino Acids , Antipsychotic Agents , Glutamic Acid , Homocysteine , Schizophrenia , Treatment OutcomeABSTRACT
CONTEXTO: Os antipsicóticos de segunda geração representam o grande avanço na terapêutica da esquizofrenia das últimas décadas, porém nos últimos anos foram sintetizados novos antipsicóticos que estão abrindo maiores perspectivas no campo do tratamento da esquizofrenia. Alguns desses medicamentos já foram lançados, enquanto outros estão em fase de testes. OBJETIVO: Apresentar uma síntese do conhecimento dos novos antipsicóticos de segunda geração. MÉTODOS: Busca por meio do PubMed e literatura específica fornecida pelos fabricantes dos medicamentos. RESULTADOS E CONCLUSÕES: São apresentadas as principais características farmacológicas, de eficácia, segurança e tolerabilidade dos seguintes antipsicóticos: Asenapina, ACP-103, Bifeprunox, Paliperidona, Risperidona de Ação Prolongada e Sertindol.
BACKGROUND: The second generation antipsychotics represent the great achievement in the treatment of schizophrenia of the last decades. However in the last years some new antipsychotics were synthesized and such new compounds may represent great perspectives for the field of the treatment of schizophrenia. Some of these compounds are in use while others are still on evaluation through clinical trials. OBJECTIVE: Summarize the current knowledge of new antipsychotics. METHODS: PubMed search as well literature provided by the manufactures. RESULTS AND CONCLUSIONS: We present the main pharmacological characteristics as well as profiles of efficacy, security and tolerability of the following compounds: Asenapine, ACP-103, Bifeprunox, Paliperidone, Long Acting Injectable Risperidone and Sertindole.
Subject(s)
Antipsychotic Agents/therapeutic use , Schizophrenia/therapy , Drug Tolerance , Antipsychotic Agents/pharmacologyABSTRACT
Neuroleptic malignant syndrome and serotonin syndrome share many common clinical features, and the term "Neurotoxic syndrome" can be used when a clear distinction cannot be made between the two. Here we present a case of 19-year-old man who experienced serotonin syndrome caused by sertraline intake, and consecutive neuroleptic malignant syndrome by risperidone. This case suggests that these two syndromes can be concomitantly induced in some patients who are susceptible to these drugs. Clinicians may have to pay close attention to this problem when prescribing drugs to patients who previously showed sensitivity to CNS-acting drugs.
Subject(s)
Humans , Young Adult , Antipsychotic Agents , Neuroleptic Malignant Syndrome , Risperidone , Serotonin Syndrome , SertralineABSTRACT
Neuroleptic malignant syndrome and serotonin syndrome share many common clinical features, and the term "Neurotoxic syndrome" can be used when a clear distinction cannot be made between the two. Here we present a case of 19-year-old man who experienced serotonin syndrome caused by sertraline intake, and consecutive neuroleptic malignant syndrome by risperidone. This case suggests that these two syndromes can be concomitantly induced in some patients who are susceptible to these drugs. Clinicians may have to pay close attention to this problem when prescribing drugs to patients who previously showed sensitivity to CNS-acting drugs.
Subject(s)
Humans , Young Adult , Antipsychotic Agents , Neuroleptic Malignant Syndrome , Risperidone , Serotonin Syndrome , SertralineABSTRACT
We described here five patients with Alzheimer's disease (AD) who have behavioral and psychological symptoms of dementia (BPSD), and who have shown a remarkable improvement as a result of Yokukansan treatment. All five patients exhibited irritability and excitement, four of the patients suffered from aggression and insomnia, and three suffered from wanderings. All of the patients started recovering from these symptoms within 1-2 weeks from the start of the treatment, without any adverse reaction. In conclusion, our case study suggests that Yokukansan is a safe and effective treatment for AD patients with BPSD. Our study further suggests that Yokukansan is especially useful for patients who are difficult to treat with neuroleptics, such as patients with insomnia and wandering, patients exhibiting a depressive state as well as irritability and excitement, and those with physical symptoms, including gait disturbances and urinary incontinence.
ABSTRACT
We report a case of rabbit syndrome in a 28-year-old man with chronic active epilepsy and mental retardation. He developed fine and rhythmic perioral involuntary movements with mild parkinsonism several months after he had been administered with neuroleptics. His movements had a rhythmic pattern consisting of 2-3 Hz with a resting period for 1- 2 seconds. They were remarkably reduced with benztropine. Parkinsonism also improved with benztropine.
Subject(s)
Adult , Humans , Antipsychotic Agents , Benztropine , Dyskinesias , Epilepsy , Intellectual Disability , Parkinsonian DisordersABSTRACT
OBJECTS: Many studies have demonstrated greater frequency of soft neurologic signs in patients with schizophrenia than in controls. However, factors associated with chronicity, institutionalization, individual differences and neuroleptic medication make it difficult to interpret these results. We report on our ongoing study of soft neurologic signs and their relationship to neuroleptics and institutionalization in schizophrenia. METHODS: Soft neurologic signs were examined with a standardized instrument, Neurological Evaluation Scale- Korean Version(NES-K) in 11 neuroleptic-naive patients with schizophrenia, 17 neuroleptic-treated patients and 14 chronically institutionalized patients. RESULTS: Scores of total items(p<0.005), sensory integration(p<0.05), sequencing of complex motor acts(p<0.05) and others(p<0.01) functional areas of NES-K were significantly different among three groups. There was no difference in the area of motor coordination. Posthoc analysis showed that scores of total items(p<0.005) and sensory integration areas(p<0.01) of NES-K were significantly higher in the institutionalized patients than those of neuroleptic-naive group. However scores of sequencing of complex motor act and others categories were not different in the institutionalized and neuroleptic-naive patients. CONCLUSION: These findings suggested that neuroleptic treatment or chronic institutionalization might partially affect soft neurologic signs, especially sensory integration area, in patients with schizophrenia. However, the soft neurologic signs of motor coordination area could be a biological trait marker of schizophrenia independent of confounding variables.
Subject(s)
Humans , Antipsychotic Agents , Individuality , Institutionalization , Neurologic Manifestations , SchizophreniaABSTRACT
About 40% of patients suffering from postencephalitic or idiopathic parkinsonism experience distressing and ill-defined sensations. Antipsychotic-induced acute extrapyramidal syndromes (EFSs) share phenomenological, pharmacological, and biochemical characteristics with these parkinsonisms. Thus, it is conceivable that antipsychotic-induced acute EPSs may also be associated with primary sensory symptoms. The aim of this study was to test this hypothesis, first by examining the frequency and risk factors of primary sensory symptoms and then by contrasting the clinical characteristics in patients with or without antipsychotic-induced acute EFSs and in patients who did or did not report sensory symptoms. The study group comprised 107 patients who receiving antipsychotics. The authors used DSM-IV criteria and Yale Extrapyamidal Symptom Scale for acute EFSs and modified McGill Pain Questionnaire for sensory symptoms. The results were as follows: 1) Twenty-one(19.6%) of 107 patients receiving antipsychotics reported sensory symptoms. Among these 21 patients, 12(57.1%) reported paresthesia, 6(28.6%) reported pain, 3(14.3%) reported both. 2) fifteen(34%) of the 44 patients with antipsychotic-induced EFSs reported sensory symptoms, while only 6(9.5%) of the 63 patients without EFSs reported sensory symptoms(p<0.01). The severity of sensory symptoms was significantly correlated with the EPSs rating score(p=0.001). 3) In the patients with sensory symptoms, the women significantly outnumbered the men(p<0.05). Any risk factor of sensory symptoms, however, couldn't be found in age, diagnosis, and drug. The subjective response including sensory symptoms were associated with drug response, drug compliance, quality of life and prognosis. It is suggested that further systematic investigation and interest about sensory symptoms and subjective response of the acute EPSs should be needed.
Subject(s)
Female , Humans , Antipsychotic Agents , Asian People , Compliance , Cross-Cultural Comparison , Diagnosis , Diagnostic and Statistical Manual of Mental Disorders , Pain Measurement , Paresthesia , Parkinsonian Disorders , Prognosis , Quality of Life , Risk Factors , SensationABSTRACT
OBJECTIVES: This study was aimed to examine the prevalence of neuroleptic-induced irregular menstruation and its related factors as well as the possible relationship of irregular menstruation with psychopathology and extrapyramidal symptoms in schizophrenic patients. METHODS: Thirty five schizophrenic inpatients at Naju National Mental Hospital who satisfied the diagnostic criteria of DSM-IV were selected. They had drug-free periods for more than 1 month before admission and had been taking neuroleptics for more than 3 months after admission. From all patients, reliable information regarding the sociodemographic characteristics, the menstrual histories before and after admission and clinical characteristics, including previous and current medications were investigated. The following were also evaluated: Serum prolactin level(by radioimmunoassay), psychopathology(by positive and negative syndrome scale: PANSS), and extrapyramidal symptoms(by extrapyramidal symptom rating scale: ESRS). RESULTS: Twelve patients(34%) showed regular menstruation and 23 patients(66%) were suffering from irregular menstruation. Of those with irregular menstruation, 13 patients(37%) had oligomenorrhea and 10 patients(29%) had amenorrhea. There were no differences in sociodemographic characteristics and menstrual histories before admission between the regular and irregular menstruation groups. But, the significant differences between the two were found in the following variables: The irregular menstruation group had shorter durations of illness, higher daily doses of current neuroleptics, higher serum prolactin levels, higher scores on the general psychopathology scale of PANSS, and higher scores on the parkinsonian symptom scale, hypokinetic symptom factor and clinical global impression of ESRS. CONCLUSION: The high prevalence of the irregular menstruation in schizophrenic patients reflects a state of hyperprolactinemia due to the interference of dopamine activity by high doses of neuroleptics.