Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-26T18:57:36.675Z Has data issue: false hasContentIssue false
  • English
  • Français

Diagnostic uncertainty in a case of neuroleptic malignant syndrome

Published online by Cambridge University Press:  21 May 2015

Dallas P. Seitz
Dallas P. Seitz*
Affiliation:
Department of Psychiatry, Queen's University, Kingston, Ont.
*
Department of Psychiatry, Hotel Dieu Hospital, 166 Brock St., Kingston ON K7L 5G2; 613 544-3310, fax 613 544-7079, seitzd@hdh.kari.net

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Neuroleptic malignant syndrome (NMS) is a potentially life-threatening condition that has been associated with antipsychotic use. Most diagnostic criteria include fever and muscle rigidity, although NMS may present without either. Diagnostic uncertainty in such cases may result in delays in diagnosis and management, leading to adverse consequences for these patients. The differential diagnosis of NMS is broad and includes a number of neurological, medical and psychiatric conditions as well as substance and medication-induced disorders. A case is described that illustrates an atypical presentation of NMS and demonstrates some of the challenges in its diagnosis. Limitations of current NMS criteria are also examined, and suggestions for future criteria are presented.

Keywords

neuroleptic malignant syndromeadverse drug reactionantipsychoticsdifferential diagnosisserotonin syndrome
Type
Case Report • Observations de cas
Information
Canadian Journal of Emergency Medicine , Volume 7 , Issue 4 , July 2005 , pp. 266 - 272
Copyright
Copyright © Canadian Association of Emergency Physicians 2005

References

1.Caroff, SN, Mann, SC. Neuroleptic malignant syndrome. Med Clin North Am 1993;77:185–202.Google Scholar
2.Farver, DK. Neuroleptic malignant syndrome induced by atypical antipsychotics. Expert Opin Drug Saf 2003;2:21–35.Google Scholar
3.Anath, J, Parameswaran, S, Guatilake, , Burgoyne, K, Sidhom, T. Neuroleptic malignant syndrome and atypical antipsychotic drugs. J Clin Psychiatry 2004;65:464–70.CrossRefGoogle Scholar
4.Nierenberg, D, Disch, M, Manheimer, E, Patterson, J, Ross, J, Sivestri, G, et al.Facilitating prompt diagnosis and treatment of the neuroleptic malignant syndrome. Clin Pharmacol Ther 1991;50:580–6.Google Scholar
5.Levenson, JL. Neuroleptic malignant syndrome. Am J Psychiatry 1985;142:1137–45.Google ScholarPubMed
6.Addonizio, G, Susman, VL, Roth, SD. Symptoms of neuroleptic malignant syndrome in 82 consecutive inpatients. Am J Psychiatry 1986;143:1587–90.Google ScholarPubMed
7.Sachdev, P, Mason, C, Hadzi-Pavlovic, D. Case-control study of neuroleptic malignant syndrome. Am J Psychiatry 1997;154:1156–8.Google Scholar
8.Pope, HG Jr, Keck, PE, McElroy, SL. Frequency and presentation of neuroleptic malignant syndrome in a large psychiatric hospital. Am J Psychiatry 1986;143:1227–33.Google Scholar
9.American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed, text rev. Washington (DC): The Association; 2000.Google Scholar
10.Adityangee, , Mathews, T, Aderibigbe, YA. Proposed research diagnostic criteria for neuroleptic malignant syndrome. Int J Neuropsychopharm 1999;2:129–44.Google Scholar
11.Addonozio, G, Susman, VL, Roth, SD. Neuroleptic malignant syndrome: review and analysis of 115 cases. Biol Psychiatry 1987;22:1004–20.Google Scholar
12.Sachdev, P, Kruk, J, Kneebone, M, Kissane, D. Clozapine-induced neuroleptic malignant syndrome: review and report of new cases. J Clin Psychopharmacol 1995;15:365–71.Google Scholar
13.Meterissian, GB. Risperidone-induced neuroleptic malignant syndrome: a case report and review. Can J Psychiatry 1996;41:52–4.CrossRefGoogle ScholarPubMed
14.Lev, R, Clark, RF. Neuroleptic malignant syndrome presenting without fever: case report and review of the literature. J Emerg Med 1994;12:49–55.Google Scholar
15.Aditanygee, , Singh, S, Singh, G, Ong, S. Spectrum concept of neuroleptic malignant Ssndrome. Br J Psychiatry 1988;153:107–11.Google Scholar
16.Balzan, MV. The neuroleptic malignant syndrome: a logical approach to the patient with temperature and rigidity. Postgrad Med J 1998;74:72–6.CrossRefGoogle Scholar
17.Shalev, A, Hermesh, H, Munitz, H. Mortality from neuroleptic malignant syndrome. J Clin Psychiatry 1989;50:18–25.Google Scholar
18.Mason, P, Victor, M, Balcezak, T. Serotonin syndrome: presentation of 2 cases and review of the literature. Medicine 2000; 79:201–9.Google Scholar
19.Serrano-Duenas, M. Neuroleptic malignant syndrome-like, or — dopaminergic malignant syndrome — due to levodopa therapy withdrawal. Clinical features in 11 patients. Parkinsonism Relat Disord 2003;9:175–8.Google Scholar
20.Casey, DE. Side effect profiles of new antipsychotic agents. J Clin Psychiatry 1996; 57(suppl 11):40–5.Google ScholarPubMed
21.Gurrera, RJ, Chang, SS, Romero, JA. A comparison of diagnostic criteria for neuroleptic malignant syndrome. J Clin Psychiatry 1992;53:56–62.Google ScholarPubMed