改良电痉挛治疗精神分裂症的临床疗效分析

作者应用改良电痉挛(modified electroconvlsive therapy，m-ECT)联合抗精神病药治疗精神分裂症，并与单独抗精神病药物治疗该症进行临床疗效比较。现将结果报道于后。     

恶性综合征3例分析

恶性综合征（Malignant syndrome,MS）又称抗精神病药物诱发的恶性综合征,神经阻滞剂致恶性综合征、植物神经综合征等,因其起病急、病情凶险,病死率在10%～20%,故早期诊断与治疗便显得十分重要,我们就最近收治的3例患的临床资料分析报道如下。     

血液灌流联合血液透析治疗恶性综合征1例

本文目的是报道血液灌流联合血液透析治疗恶性综合征1例,为相应临床诊疗提供参考。1例31岁的男性精神分裂症患者接受抗精神病药物治疗11天出现发热、意识障碍、肌张力增高、肌酸激酶升高等,诊断为抗精神病药物所致恶性综合征,立即停用抗精神病药,给予对症治疗,并进行血液灌流联合血液透析治疗两次,抢救18小时后,患者意识清晰;治疗第5天,患者好转出院。     

肉毒毒素A治疗Meige综合征

肉毒毒素Ａ治疗Ｍｅｉｇｅ综合征黄新民Ｍｅｉｇｅ综合征又称睑痉挛、口下颌肌张力障碍综合征，１９１０年首先由Ｍｅｉｇｅ报道，是成年起病的一种变形性肌张力障碍，主要为睑痉挛和口面部异常运动。应用Ａ型肉毒毒素（ＢＴＸＡ）治疗此病是８０年代治疗学上的一个新进展...     

恶性综合征2例并文献复习

目的探讨恶性综合征的临床特点,以提高对本病的认识。方法回顾性分析2例确诊的恶性综合征患者的临床资料并复习相关文献。结果 2例均有抗精神病药物服用史,临床表现为发热、肌强直、肌酶增高、意识障碍及自主神经功能障碍,影像学等检查排除其他疾病,综合治疗有效。结论恶性综合征临床少见,多有抗精神病药物服药史,主要与药物影响脑内递质有关,肌酶增高为主要诊断依据,及时治疗大多预后良好。     

碳酸锂结合氟哌啶醇致恶性综合征(英文)

一名39岁的女性双相障碍患者因再次出现伴精神病性症状的躁狂发作而住院,总病程20年。用常规剂量的碳酸锂和氯氮平治疗。入院3天后,患者出现攻击行为,并拒绝服药,因而停用氯氮平口服,予氟哌啶醇肌注。3天后,患者出现高热以及其他恶性综合征的表现,如大量出汗,肢体肌肉痉挛、震颤,肌强直以及意识障碍。立刻停用氟哌啶醇和锂盐,对症支持治疗,同时用多巴胺激动剂溴隐亭治疗。恶性综合征的症状在3天内缓解,但精神病性症状依然很严重。继而使用丙戊酸钠和奥氮平治疗,未再出现恶性综合征。又治疗1个月后,患者康复出院。过去有若干个病例也与此类似,这些病例提示抗精神病药物合并锂盐治疗引起恶性综合征的风险可能比单用一种抗精神病药物要高。当然病例报告本身无法证实这一点。     

介绍一种恶性综合征评定量表——Francis-Yacoub恶性综合征评定量表

<正>恶性综合征(Neuroleptic Malignant Syndrome,NMS)首先由Deley等[1]于1960年报道,是一种与抗精神病药物治疗有关的严重并发症,以高热、肌强直、自主神经功能紊乱和精神状态的改变为特征[1-2]。目前,国内尚无恶性综合征严重程度评定量表。现介绍一种恶性综合征评定量表——Francis-Yacoub恶性综合征评定量表。     

电运动治疗第三腰椎横突综合征临床疗效探讨

目的 探讨电运动治疗第三腰椎横突综合征的效果.方法 对27例第三腰椎横突综合征运用电运动治疗.结果 电运动治疗第三腰椎横突综合征总有效率为92.6%.结论 电运动治疗第三腰椎横突综合征,有消炎、镇痛,解除腰部肌肉痉挛,改善局部神经和组织营养代谢作用,使腰疼痛症状得以缓解.     

电休克治疗恶性症状群2例报告

抗精神病药恶性症状群(NMS)应用电休克疗法(ECT)治疗,国外文献报道不少,在国内开展的病例尚不多。本文报道我院2例NMS患者用ECT治疗的经验,并结合国内外文献进行讨论。     

立体定向放射外科治疗药物难治性癫痫

立体定向放射外科（stereotactic radiosurgery，SRS）治疗药物难治性癫痫早有报道，具有定位精确，对周围组织损伤小、疗效好、安全、无创等优点。近年随着神经影像学、神经电生理的发展，国内外报道SRS治疗药物难治性癫痫病例明显增多。现结合文献，就SRS治疗药物难治性癫痫在治疗机制、癫痫灶定位、靶区设定、照射剂量等方面的进展综述如下。     

Neuroleptic malignant syndrome due to atypical neuroleptics: three episodes in one patient

Neuroleptic malignant syndrome (NMS) is a rare, but potentially lethal complication of antipsychotic medication. The risk of developing NMS under atypical neuroleptics seems lower than under typical neuroleptics. However, the use of atypical neuroleptics in modern psychopharmacotherapy is increasing, so the incidence of NMS under these drugs may also increase. Here, we will describe three episodes of NMS that fulfilled the DSM-IV criteria for NMS (APA, 1994). The epivodes of NMS occured under treatment with clozapine, risperidone, and amisulpride. These episodes had some atypical features that will be discussed with regard to the pathophysiological mechanisms leading to NMS.     

Neuroleptic malignant syndrome induced by ziprasidone on the second day of treatment.

Neuroleptic malignant syndrome (NMS) is the rarest and most serious of the neuroleptic-induced movement disorders. We describe a case of neuroleptic malignant syndrome (NMS) associated with the use of ziprasidone. Although conventional neuroleptics are more frequently associated with NMS, atypical antipsychotic drugs like ziprasidone may also be a cause. The patient is a 24-year-old male with a history of schizophrenia who developed signs and symptoms of NMS after 2 days of treatment with an 80-mg/day dose of orally administrated ziprasidone. This case is the earliest (second day of treatment) NMS due to ziprasidone reported in the literature.     

A case of recurrent neuroleptic malignant syndrome

Summary:Neuroleptic malignant syndrome (NMS) is a life-threatening neurologic complication associated with the use of neuroleptic agents and characterized by a distinctive clinical syndrome of fever, r...     

ECT as a treatment alternative for patients with symptoms of neuroleptic malignant syndrome

The use of ECT as a treatment alternative in a clinical situation in which it is difficult to determine whether the patient is suffering from neuroleptic malignant syndrome (NMS) or an evolving catatonic state is investigated. Fourteen cases from the literature are reviewed and 3 new cases are presented. In 6 cases, ECT was rapidly effective in treating symptoms of NMS, but cardiac arrhythmias were reported in 4 cases. There was no evidence of malignant hyperthermia (MH) in patients receiving succinylcholine, suggesting that an association between NMS and MH may not be clinically relevant in patients being treated with ECT.     

Neuroleptic malignant syndrome and serotonin syndrome in the critical care setting: case analysis.

BACKGROUND: Serotonin syndrome (SS) and neuroleptic malignant syndrome (NMS) are medical emergencies associated with psychotropic administration. Differentiation and treatment can be complex, especially when features of both syndromes are present and the patient has taken both serotonergic and neuroleptic agents. METHOD: Case analysis of a poly-drug overdose (venlafaxine, topiramate, divalproex sodium, risperidone, and carbamazepine) presenting with mixed SS/NMS features and whose clinical management suggests a practical algorithm for treatment of undifferentiated SS/NMS in critical care settings. RESULTS: The suggested algorithm includes: 1) Supportive care and withdrawal of all potentially offending agents; 2) Laboratory evaluation with prompt initiation of treatment for both disorders--cyproheptadine for SS and dantrolene for NMS; 3) Do not use bromocriptine (contraindicated in SS) or chlorpromazine (contraindicated in NMS) initially; 4) Add bromocriptine when clinical presentation becomes consistent with NMS (SS can be prolonged if serotonergic agent has long half-life). CONCLUSIONS: Prompt and appropriate identification and intervention are essential for successful management of SS and NMS. The suggested treatment algorithm allows for specific treatment of both disorders and avoids potentially exacerbating either one. The algorithm derived from this case could serve as both a practical guideline and impetus for further investigation in light of increasing psychotropic co-administration.     

Syndrome malin des neuroleptiques et difficultés diagnostiques : à propos d’un cas

BackgroundNeuroleptic malignant syndrome (NMS) is an uncommon but potentially fatal adverse effect of neuroleptic drugs. It is commonly characterized by muscular rigidity, fever, altered mental status, and autonomic dysfunction. Emerging of NMS is possible with all neuroleptics, classic and atypical. NMS occurs most often during the first week of treatment or after increasing the dosage of the neuroleptic medication. The frequency of NMS ranges from 0.07 to 2.2%. Its pathophysiology is not clearly understood but the blockade of dopamine receptors appears to be the central mechanism. Issues of NMS are those of diagnosis, treatment and reintroduction of antipsychotic treatment or not.ObjectiveWe here present an interesting case because of its atypical clinical presentation and its slow resolution, illustrating the various problems linked to the NMS.Case reportA 55-year-old woman with a history of mental retardation and infantile psychosis is hospitalized for worsening of her psychiatric symptoms. She is treated by risperidone long-acting injection every 2 weeks, escitalopram 20 mg/d and oxazepam 10 mg/d. Early December 2012, she had fever spikes treated with many antibiotics and neuroleptics were stopped, without improvement. Early January 2013, a pulmonary embolism was diagnosed, and a treatment with loxapine is introduced and her injection of risperidone is done because of the state of agitation of the patient. Two weeks later, a NMS is suspected to hyperthermia, tremor of the limbs, a slight stiffness, and neuroleptics are stopped. Dantrolene is then introduced, but after 7 days of treatment the fever is still important. Other assumptions are then discussed: infection, serotonin syndrome, encephalopathy, catatonia, malignant hyperthermia. But diagnosis of NMS is finally retained because of the recurrence of symptoms after introduction of clozapine early February.DiscussionIn this patient, diagnosis was made more difficult by the use of long-acting neuroleptic. NMS was indeed partly rejected because of the lack of improvement despite 7 days of dantrolene treatment, but the release of risperidone lasts 7 weeks after the injection. This NMS is also of atypical presentation with a minor muscular rigidity. And this case is particularly interesting because of the recurrence of NMS with clozapine, allowing to finally diagnose it. This atypical neuroleptic is not known to be a major provider of NMS but the very short period before reintroduction and possible persistence of risperidone in the body could explain the recurrence.ConclusionNMS can be hard to diagnose. It is a diagnosis of exclusion, but we should keep in mind that there is great variability of its clinical presentation in order to not exclude too quickly this syndrome in a patient treated by neuroleptic.     

非典型抗精神病药物所致恶性综合征的临床特征

本文目的是探讨非典型抗精神病药物所致恶性综合征(NMS)的临床特征,为临床早期诊断和治疗提供参考。抗精神病药物所致NMS是一种严重的药物不良反应,几乎所有的抗精神病药物均可引起。与典型抗精神病药物相比,非典型抗精神病药物所致NMS发生率更低、病情更轻、死亡率更低。不同种类非典型抗精神病药物所致NMS临床特点各异。对于老年人及应用抗抑郁药物者发生的NMS尤应引起重视,因为这些因素可增加死亡的风险。     

Neuroleptic malignant syndrome treated with subcutaneous lisuride infusion

A schizophrenic patient developed a characteristic clinical picture of neuroleptic malignant syndrome (NMS) while admitted to the hospital during an exacerbation of his psychiatric symptoms. Oral treatment of the NMS with bromocriptine (7.5 mg/day) or levodopa/carbidopa (125/12.5 mg) provoked intense vomiting in spite of domperidone (60 mg/day), which led to their discontinuation. In view of the deterioration of the symptoms, treatment was begun with lisuride (1-2 mg/24 h) subcutaneously. An obvious improvement was shown in 24 h, but levodopa/carbidopa (125/12.5 mg t.d.s. orally) had to be added later to achieve complete resolution of the NMS. During the recovery phase, while being treated with subcutaneous lisuride infusion and levodopa (p.o.), the patient presented with confusion, agitation, and hallucination. Lisuride infusion was stopped and levodopa was continued until complete resolution of the NMS. This case indicates that parenteral administration of lisuride or other dopamine agents such as levodopa (i.v.) or apomorphine (s.c.) may be considered an effective and practical way of treating NMS, particularly when the patient's condition makes it difficult or impossible to use other dopaminergic drugs by the oral route.     

A ten-year-old autistic girl with neuroleptic malignant syndrome caused by neuroleptic agents

We reported a ten-year-old autistic girl who had developed neuroleptic malignant syndrome (NMS) caused by administration of neuroleptic agents, haloperidol and chlorpromazine, because of her behavioral disorders. She had fever (38.4 degrees C) and elevated CK (796 IU). Her extrapyramidal symptoms and autonomic disturbance improved gradually after discontinuation of these drugs. However, altered consciousness did not change for three months despite treatment with L-DOPA, bromocriptine, dantrolene Na, biperiden, diltiazeM HCL and diazepam. Administration of amantadine HCL dramatically cleared not only the persistent symptom but also extrapyramidal symptoms and autonomic disturbance. She recovered from NMS one month later. The study of this case indicated that these neuroleptic drugs could cause NMS also in children. Therefore, the use of them in children with behavioral problems should be carefully evaluated clinically. It was concluded that NMS in this case occurred due to a defective dopamine release from presynaptic vesicles because L-DOPA was not effective and amantadine HCL was effective against these symptoms.     

Intravenous administration of lisuride in the treatment of neuroleptic malignant syndrome.

The neuroleptic malignant syndrome (NMS) is a very rare but life-threatening complication of neuroleptic treatment. The mortality of NMS has been estimated at 8-30% and the most common cause of death is respiratory failure. Signs and symptoms of NMS are attributed to impairment of dopaminergic neurotransmission in the central nervous system. We describe two cases of NMS successfully treated with intravenous lisuride in combination with oral L-Dopa.