Neuroleptic malignant syndrome comes about, most likely, as
a result of “dopamine D2 receptor antagonism”
. Dopamine is a chemical substance (neurotransmitter) found in the brain and elsewhere in the central nervous system that acts to convey messages from one cell to another.
Why do antipsychotics cause neuroleptic malignant syndrome?
The most widely accepted mechanism by which antipsychotics cause neuroleptic malignant syndrome is that
of dopamine D2 receptor antagonism
. In this model, central D2 receptor blockade in the hypothalamus, nigrostriatal pathways, and spinal cord leads to increased muscle rigidity and tremor via extrapyramidal pathways.
What causes neuroleptic malignant syndrome?
Neuroleptic malignant syndrome (NMS) is a severe disorder caused by
an adverse reaction to medications with dopamine receptor-antagonist properties or the rapid withdrawal of dopaminergic medications
.
What does neuroleptic malignant syndrome do to you?
Neuroleptic malignant syndrome (NMS) is a
rare reaction to antipsychotic drugs that treat schizophrenia, bipolar disorder
, and other mental health conditions. It affects the nervous system and causes symptoms like a high fever and muscle stiffness. The condition is serious, but it’s treatable.
Do typical antipsychotics cause neuroleptic malignant syndrome?
Neuroleptic malignant syndrome (NMS) is
a rare but potentially fatal adverse event associated with the use of antipsychotics
. Although atypical antipsychotics were initially considered to carry no risk of NMS, reports have accumulated over time implicating them in NMS causation.
How can you prevent neuroleptic malignant syndrome?
The most important aspect of treatment is prevention. This includes reducing risk factors (e.g. dehydration, agitation and exhaustion), early recognition of
suspected cases
and prompt discontinuation of the offending agent.
How is neuroleptic malignant diagnosed?
The diagnosis of NMS is
based on history and the presence of certain physical examination and laboratory findings
. Patients typically develop NMS within hours or days after exposure to a causative drug, with most exhibiting symptoms within 2 weeks and nearly all within 30 days.
Which medication is associated with the highest risk of tardive dyskinesia?
Antipsychotic drugs known as neuroleptics
are the most common cause of tardive dyskinesia.
Why is NMS a medical emergency?
Neuroleptic malignant syndrome (NMS) is a
lethal medical emergency associated with the use of neuroleptic agents and antiemetics
that is characterized by a typical clinical syndrome of hyperthermia, rigidity, mental status alteration, and dysautonomia.
How do you manage a patient who develops neuroleptic malignant syndrome while on an atypical antipsychotic?
- Benzodiazepines for restraint may be useful.
- Stop all neuroleptics.
- Correct volume depletion and hypotension with intravenous fluids.
- Reduce hyperthermia.
How do you manage neuroleptic syndrome?
Nonpharmacologic management centers
on aggressive supportive care including vigilant nursing, physical therapy, cooling, rehydration, anticoagulation. Pharmacologic interventions include immediate discontinuation of antipsychotics, judicious use of anticholinergics, and adjunctive benzodiazepines.
Can antidepressants cause neuroleptic malignant syndrome?
Like NMS, SS often occurs when beginning a new drug or increasing the dosage of a current drug. Many drugs can cause the condition, but it’s most often associated with antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs).
Is Serotonin syndrome the same as neuroleptic malignant syndrome?
NMS and
serotonin syndrome are rare
, but potentially life-threatening, medicine-induced disorders. Features of these syndromes may overlap making diagnosis difficult. However, NMS is characterised by ‘lead-pipe’ rigidity, whilst serotonin syndrome is characterised by hyperreflexia and clonus.
Are neuroleptics and antipsychotics the same thing?
Formerly known as major tranquilizers and neuroleptics, antipsychotic medications are the main class of drugs used to treat
people
with schizophrenia. They are also used to treat people with psychosis that occurs in bipolar disorder, depression and Alzheimer’s disease.
When do you get neuroleptic malignant syndrome?
NMS is most common
after initiation
or increase in dosage of neuroleptic therapy and in 90% of cases this occurs within 10 days. The onset is usually gradual over 1 to 3 days and tends to occur within four weeks of starting or increasing neuroleptic medication.
Which of the following increases the risk for neuroleptic malignant syndrome NMS )?
One of the clearest risk factors in the development of NMS is the course of drug therapy chosen to treat a condition.
Use of high-potency neuroleptics, a rapid increase in the dosage of neuroleptics
, and use of long-acting forms of neuroleptics are all known to increase the risk of developing NMS.
