多次利培酮治疗致抗精神病药恶性综合征

1例31岁女性患者因精神分裂症给予利培酮1 mg,2次/d口服,1周后剂量增至2 mg,2次/d。此前患者曾3次间断应用利培酮治疗。本次治疗规律服药49 d,患者精神症状缓解。第50～52天未遵医嘱规律服药。第54天患者出现大汗淋漓,体温达38.5℃。第55天出现意识障碍、心动过速、双上肢肌强直、肌张力增高。心电图示窦性心动过速。实验室检查示:白细胞计数12.3×109/L,胆碱酯酶13 268 U/L,肌酸激酶1447 U/L,利培酮血液浓度70.5μg/L。诊断为抗精神病药恶性综合征(NMS)。立即停用利培酮,进行物理降温、补液、抗心律失常、抗感染、纠正酸碱平衡、护肝等治疗。6 d后患者体温恢复正常,NMS症状消失。换用奥氮平治疗后,未再出现类似症状。     

Neuroleptic malignant syndrome

While on holiday in Zimbabwe, a forty-one year old woman with a long history of intermittent psychiatric illness developed what was diagnosed as neuroleptic malignant syndrome. She was admitted to the Intensive Care Unit of Harare Central Hospital and was treated successfully with bromocriptine and dantrolene.     

Neuroleptic malignant syndrome associated with the use of risperidone,an atypical antipsychotic agent

Neuroleptic malignant syndrome (NMS) is a rare and sometimes fatal adverse reaction to neuroleptic drugs. Atypical antipsychotic agents, such as risperidone, are thought to be less likely to cause NMS because of their pharmacological profile. This is a case report of NMS associated with risperidone treatment.     

Neuroleptic malignant syndrome in cycloserine-induced psychosis

A 33-year-old multidrug-resistant tuberculosis female patient diagnosed as cycloserine-induced psychosis developed several neuroleptic side effects such as extrapyramidal reaction, neuroleptic malignant syndrome, and drug-induced parkinsonism while she was being treated with initially haloperidol and then olanzapine over a period of 2 months. Patient''s antipsychotic medications were withdrawn, and treatment with bromocriptine showed prompt recovery. The multiple neurological adverse effects which the patient developed had implications on the management of the complications as well as her illness.KEY WORDS: Cycloserine, multidrug-resistant tuberculosis, neuroleptic malignant syndrome, parkinsonism     

喹硫平致恶性综合征

患者女,60岁。以“多疑、认为有人害她、自语,反复发作35年,加重6个月”于2006年3月17日入院。患者近半年因疑人陷害、下毒,饮食不规律,未服用抗精神病药物。入院后查体:患者营养欠佳,口角稍向左歪,余未发现阳性体征。脑部CT平扫示:脑梗塞。化验检查:血、尿、便常规、肝功能、肾功能正常。心电图示:T波改变。诊断:精神分裂症,脑梗塞。躯体疾病进行对症处理;给予喹硫平(Seroquel,思瑞康)抗精神病治疗,起始剂量25mg/d口服。同时因兴奋、冲动,曾于入院后1周内间断给予小剂量氟哌啶醇5mg肌内注射。将喹硫平缓慢加量,于15d时加至400mg/d,精神症…     

Neuroleptic malignant syndrome during perphenazine treatment

A 50-year old woman developed symptoms of a neuroleptic malignant syndrome with myoglobinuric renal failure during treatment with perphenazine. After discontinuation of perphenazine and repetitive haemodialysis, the patient recovered. Clinical characteristics of the syndrome, differential diagnosis and various therapeutic possibilities are shortly reviewed.     

Neuroleptic malignant syndrome due to olanzapine

Neuroleptic malignant syndrome (NMS) is a rare and potentially fatal complication precipitated by the use of antipsychotic medications, most notably haloperidol. Criteria previously described include: exposure to the neuroleptic class of medications; hyperthermia; muscle rigidity; a cluster of laboratory and physical findings that may include mental status changes, autonomic instability, creatine phosphokinase elevation and leukocytosis, and exclusion of other causes for the patient's condition. A prodrome of mental status changes, autonomic instability, tremors, diaphoresis, excess salivation, and extrapyramidal signs may precede NMS. Prior reports of NMS linked to olanzapine have been in patients who had been previously treated with other neuroleptic agents or in patients who had previous episodes of NMS precipitated by other neuroleptics. Several cases included patients treated with olanzapine in addition to another neuroleptic. This report describes a case of NMS associated with olanzapine in a patient who had not previously been exposed to the neuroleptic drug class. At the time this patient presented, there were no reports in the literature of NMS associated with olanzapine alone. Treatment of NMS includes: immediate withdrawal of all neuroleptics; supportive care; fever control; management of autonomic instability (tachycardia, tachypnea, blood pressure fluctuations); and pharmacologic management with dantrolene and bromocriptine.     

Neuroleptic malignant syndrome: case report and review

A patient with neuroleptic malignant syndrome is reported. The clinical features, complications and management are discussed and literature reviewed.