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    Neuroleptic Malignant Syndrome: Diagnosis and Management.
    Prim Care Companion CNS Disord 2018 Jan 4;20(1). Epub 2018 Jan 4.
    Department of Community Health and Family Medicine, 1707 N Main St, Gainesville, FL 32609.
    Objective: To provide an overview of neuroleptic malignant syndrome (NMS) for the general practitioner with the most up-to-date information on etiology, workup, and management.

    Data Sources: The search using PubMed included articles with the key words neuroleptic malignant syndrome, antipsychotics, neuroleptics, diagnosis, and treatment of neuroleptic malignant syndrome published in English from January 2000 to 2017. Single-case reports and articles dealing with the pediatric patient population were excluded. Read More

    Neuroleptic malignant syndrome as a presenting feature of subacute sclerosing panencephalitis.
    J Neurovirol 2017 Dec 14. Epub 2017 Dec 14.
    Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
    Subacute sclerosing panencephalitis (SSPE) is a slowly progressive degenerative disorder caused by measles virus. It is characterised by typical clinical and electrophysiological features in the form of slow myoclonic jerks, with progressive cognitive impairment, visual symptoms, and periodic complexes on EEG, with raised titres of anti-measles antibodies in CSF and serum. Atypical presentations of SSPE have been reported including brainstem involvement, ADEM-like presentation, acute encephalitis, and cerebellar ataxia. Read More

    Life-threatening parkinsonism-hyperpyrexia syndrome following bilateral deep brain stimulation of the subthalamic nucleus.
    Neurol Neurochir Pol 2017 Dec 6. Epub 2017 Dec 6.
    Department of Neurosurgery, Liv Hospital, Istanbul, Turkey.
    Parkinsonism-hyperpyrexia syndrome (PHS), or neuroleptic malignant syndrome (NMS), is a neurophysiologic reaction to the acute withdrawal/decrease of central dopamine levels. It is a severe complication characterized by rigidity, change in consciousness level, fever, hypertension, and autonomic instability, that can be fatal. To the best of our knowledge, PHS following deep brain stimulation (DBS) of subthalamic nucleus (STN) surgery due to anti-Parkinson drug discontinuation has been previously reported only six times. Read More

    The Treatment of Clozapine-Withdrawal Delirium with Electroconvulsive Therapy.
    Case Rep Psychiatry 2017 2;2017:1783545. Epub 2017 Nov 2.
    Adult Mental Health Unit, The Canberra Hospital, ACT Health, GPO Box 825, Canberra, ACT 2601, Australia.
    Clozapine, a commonly used atypical antipsychotic, can precipitate a severe withdrawal syndrome. In this report, we describe a case of delirium with catatonic features emerging after the immediate cessation of clozapine subsequent to concerns of developing neuroleptic malignant syndrome. After multiple treatments were found to be inefficacious, electroconvulsive therapy (ECT) was initiated, resulting in significant improvement. Read More

    [Neuroleptic malignant syndrome].
    Nervenarzt 2017 Dec 5. Epub 2017 Dec 5.
    Klinische Pharmakologie am Lehrstuhl für Pharmakologie und Toxikologie, Universität Regensburg, Regensburg, Deutschland.
    Background: Neuroleptic malignant syndrome (NMS) is a rare but severe undesired complication of psychopharmacological treatment. The mortality has shown a significant decrease since its first description. Knowledge of NMS is important for every clinician because of the need for rapid diagnosis and treatment. Read More

    Controversies in Serotonin Syndrome Diagnosis and Management: A Review.
    J Clin Diagn Res 2017 Sep 1;11(9):OE05-OE07. Epub 2017 Sep 1.
    Internal Medicine Resident, Ziauddin Medical University Hospital, Karachi, Pakistan.
    Over the past few years, Serotonin Syndrome (SS) has become a significant clinical concern. Over the last decade, United States saw a surge in antidepressant use. SS characteristically presents as the triad of altered mental status, autonomic dysfunction and neuromuscular excitation. Read More

    Encephalitis associated with antibodies against the NMDA receptor.
    Med Clin (Barc) 2017 Nov 25. Epub 2017 Nov 25.
    Servei de Neurologia, Institut Clínic de Neurociències, Hospital Clínic, Universitat de Barcelona, Barcelona, España; Laboratori d'Immunologia Clínica i Experimental, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Department of Neurology, University of Pennsylvania, Philadelphia, EE. UU.; Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, España. Electronic address:
    The encephalitis associated with antibodies against the N-methyl-D-aspartate receptor (NMDAR) is characterized by the presence of antibodies against the GluN1 subunit of this receptor, resulting in symptoms that are similar to those observed in models of genetic or pharmacologic reduction of NMDARs. Patients are usually young adults, predominantly women, and children who develop, in a sequential manner, rapidly progressive symptoms including psychosis, abnormal movements, autonomic dysfunction, and coma. Epileptic seizures are variable and can occur throughout the course of the disease. Read More

    Neuroleptic Malignant Syndrome Following Bilateral Cemented Total Hip Replacements.
    Bull Hosp Jt Dis (2013) 2017 Dec;75(4):286-288
    Neuroleptic malignant syndrome (NMS) is a rare, serious complication caused by neuroleptic medications. It is characterized by rigidity, hyperthermia, tachycardia, leukocytosis, and an elevated creatine kinase (CK). We present a case of a 50-year-old male who underwent bilateral total hip replacements and subsequently developed NMS. Read More

    Zuclopenthixol dihydrochloride for schizophrenia.
    Cochrane Database Syst Rev 2017 11 16;11:CD005474. Epub 2017 Nov 16.
    Sheffield Health and Social Care, NHS Foundation Trust, Fulwood House, Old Fulwood Road, Sheffield, UK, S10 3TH.
    Background: Oral zuclopenthixol dihydrochloride (Clopixol) is an anti-psychotic treatment for people with psychotic symptoms, especially those with schizophrenia. It is associated with neuroleptic malignant syndrome, a prolongation of the QTc interval, extra-pyramidal reactions, venous thromboembolism and may modify insulin and glucose responses.

    Objectives: To determine the effects of zuclopenthixol dihydrochloride for treatment of schizophrenia. Read More

    Capsaicin Cream for Treatment of Cannabinoid Hyperemesis Syndrome in Adolescents: A Case Series.
    Pediatrics 2017 Dec 9;140(6). Epub 2017 Nov 9.
    Section of Emergency Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus, and.
    Cannabinoid hyperemesis syndrome (CHS) is an underrecognized diagnosis among adolescents. In the adult literature, it is characterized as nausea, vomiting, and abdominal pain in patients with chronic marijuana use. CHS is often refractory to the standard treatment of nausea and vomiting. Read More

    Parkinson's disease: nursing care in emergency settings.
    Emerg Nurse 2017 Sep;25(5):34-39
    Torbay Hospital, Torbay and South Devon NHS Foundation Trust, Torquay, England.
    In the UK 127,000 people are diagnosed with Parkinson's disease, many of whom are frequently admited to hospital. However, Parkinson's disease is not usually the primary cause of admission. Emergency department (ED) nurses must be aware of the medication needs of people with Parkinson's disease and how these can be met in emergency setings to ensure the stability of their condition and to prevent the development of neuroleptic malignant syndrome, a potentially fatal condition caused by abrupt omission of Parkinson's medication. Read More

    Neuroleptic malignant syndrome: A neuro-psychiatric emergency: Recognition, prevention, and management.
    Asian J Psychiatr 2017 Oct 4;29:106-109. Epub 2017 May 4.
    Professor Psychiatry, Northern Ontario School of Medicine, Laurentian and Lakehead University, Ontario, Canada; Emeritus Professor Psychiatry, Schulich School of Medicine, Western University, Ontario, Canada. Electronic address:
    Neuroleptic Malignant Syndrome (NMS) is a life threatening complication of antipsychotic therapy. It is often assumed to be rare. Observations suggest that rather than overestimating its frequency, we are more likely to underestimate it (Pope et al. Read More

    Neuroleptic malignant syndrome in a patient with stable dose of olanzapine.
    J Family Med Prim Care 2017 Jan-Mar;6(1):158-160
    Department of Medicine, Tata Main Hospital, Jamshedpur, Jharkhand, India.
    Neuroleptic malignant syndrome (NMS), a potentially fatal consequence due to typical neuroleptics, has been described so far. In the past few years, there has been increased use of atypical antipsychotic drugs. Cases of NMS related to atypical neuroleptics, such as olanzapine, are less common in spite of increasing cases reported in literatures. Read More

    Neuroleptic malignant syndrome with thyroid disorder: An unusual case report.
    Medicine (Baltimore) 2017 Sep;96(39):e8191
    aDepartment of Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn bRoss University School of Medicine, Portsmouth, Dominica cDivision of Endocrinology, Brookdale University Hospital and Medical Center, Brooklyn, New York.
    Rationale: Neuroleptic malignant syndrome (NMS) is a life threatening neurologic emergency associated with neuroleptic or antipsychotic agent use. NMS is rarely related to thyroid disease.

    Patient Concerns: We report a case of NMS in a 66-year-old male with past medical history of paranoid schizophrenia on chlorpromazine, diabetes, hypertension and asthma, who presented with a humeral fracture after a fall. Read More

    "Brief" Aripiprazole-induced Neuroleptic Malignant Syndrome with Symptoms that Only Lasted a Few Hours.
    Intern Med 2017 Nov 25;56(22):3089-3092. Epub 2017 Sep 25.
    Department of Surgery, Bellland General Hospital, Japan.
    Neuroleptic malignant syndrome (NMS) with characteristic symptoms is a potentially lethal reaction to antipsychotic drugs. Atypical NMS usually lacks major symptoms and frequently occurs after treatment using atypical antipsychotics, such as aripiprazole. A 64-year-old man developed aripiprazole-induced NMS after surgery, and our early recognition of the NMS was based on high creatine kinase levels and low serum iron levels. Read More

    Malignant Syndrome and Serotonin Syndrome in a General Hospital Setting: Clinical Features, Frequency and Prognosis.
    Intern Med 2017 Nov 25;56(21):2865-2869. Epub 2017 Sep 25.
    Department of Neurology, Graduate School of Medicine, Chiba University, Japan.
    Objective The differences in the frequency and clinical features of malignant syndrome (MS) and serotonin syndrome (SS) in same population have only rarely been reported. To report the frequency and clinical features of MS and SS in a general hospital setting. Methods The clinical and laboratory features of patients with MS and those with SS, who were consecutively admitted to Chiba Rosai Hospital, during the past 4. Read More

    Hypothermia due to Antipsychotic Medication: A Systematic Review.
    Front Psychiatry 2017 7;8:165. Epub 2017 Sep 7.
    Parnassia Psychiatric Institute, The Hague, Netherlands.
    Background: Hypothermia is a rare, but potentially fatal adverse effect of antipsychotic drug (APD) use. Although the opposite condition, hyperthermia, has been researched extensively in the context of the malignant antipsychotic syndrome, little is known about hypothermia due to APDs.

    Objective: This study aimed to review the literature on hypothermia in the context of APD use, and formulate implications for research and clinical care. Read More

    Drug information update. Atypical antipsychotics and neuroleptic malignant syndrome: nuances and pragmatics of the association.
    BJPsych Bull 2017 Aug;41(4):211-216
    Government Medical College and Hospital, Chandigarh, India.
    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. Almost all atypical antipsychotics have been reported to be associated with NMS. Read More

    Acute Presentation of Nonmotor Symptoms in Parkinson's Disease.
    Int Rev Neurobiol 2017 10;134:973-986. Epub 2017 Jul 10.
    Icahn School of Medicine at Mount Sinai, New York, NY, United States. Electronic address:
    There are a few syndromes involving the nonmotor symptoms of Parkinson's disease and other movement disorders that can quickly lead to severe morbidity and mortality, and, as such, need rapid identification and management. Among these are neuroleptic malignant syndrome, serotonin syndrome, dopamine agonist withdrawal syndrome, and dystonic storm. It is important to maintain a high index of suspicion for these disorders as lack of identification can lead to death. Read More

    [Treatment of hyperthermia].
    Ugeskr Laeger 2017 Jul;179(30)
    Hyperthermia is an uncontrolled elevation of body temperature exceeding the body's ability to dissipate heat. Hyperthermia can result in dangerously high core temperatures and can rapidly become fatal. Common causes include heat stroke, malignant hyperthermia, serotonin syndrome, neuroleptic syndrome, a few endocrine emergencies as well as numerous intoxications. Read More

    Movement side effects of antipsychotic drugs in adults with and without intellectual disability: UK population-based cohort study.
    BMJ Open 2017 Aug 3;7(8):e017406. Epub 2017 Aug 3.
    Division of Psychiatry, University College London, London, UK.
    Objectives: To measure the incidence of movement side effects of antipsychotic drugs in adults with intellectual disability and compare rates with adults without intellectual disability.

    Design: Cohort study using data from The Health Improvement Network.

    Setting: UK primary care. Read More

    Atypical Neuroleptic Malignant Syndrome: Diagnosis and Proposal for an Expanded Treatment Algorithm: A Case Report.
    A A Case Rep 2017 Dec;9(12):339-343
    From the Department of Anesthesiology & Perioperative Medicine and Division of Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
    Neuroleptic malignant syndrome (NMS) in the absence of an elevated creatine kinase is atypical and more difficult to diagnose. We present a patient with NMS significant risk factors who developed atypical NMS 6 days after a liver transplant. Symptoms of hyperthermia, altered mental status, dyskinesia, and autonomic instability (hypertension and tachycardia) coincided with promethazine administration, with rapid progression to fulminant NMS with lead pipe rigidity after a single injection of intramuscular ziprasidone. Read More

    [Prolonged neuroleptic malignant syndrome after Haloperidol injection].
    Med Klin Intensivmed Notfmed 2017 Jul 27. Epub 2017 Jul 27.
    Klinik für Innere Medizin I, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
    Neuroleptic malignant syndrome (NMS) is a rare disorder caused by drug-induced dopamine-receptor-blockage or low dopamine concentration in the brain. It is a severe reaction to neuroleptic drugs in antipsychotic therapy. Symptoms in NMS typically consist of fever, muscle rigidity and cognitive changes; laboratory findings include elevated infectious disease markers and creatine kinase as well as signs of rhabdomyolysis. Read More

    Olanzapine induced neuroleptic malignant syndrome, treated with electroconvulsive therapy (ECT)-A case report.
    Asian J Psychiatr 2017 Dec 14;30:230-231. Epub 2017 Jul 14.
    NIMHANS, Bengaluru, India; Professor of Psychiatry and I/C Head of Psychiatric Rehabilitation Services, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru 560029, India; NIMHANS, Bengaluru, India. Electronic address:

    Transient lesions of the splenium of the corpus callosum following rapid withdrawal of levetiracetam.
    Epileptic Disord 2017 Sep;19(3):379-382
    Department of Psychiatry, Hokkaido University Graduate School of Medicine, Hokkaido.
    Transient lesions of the splenium of the corpus callosum are characterized by MRI findings. The lesions are very rare, but significant from a clinical standpoint as differential diagnoses include serious conditions such as encephalitis, meningitis, and neuroleptic malignant syndrome. In addition, it is reported that some are attributed to the withdrawal of antiepileptic drugs. Read More

    Neuropsychiatric Manifestations of Scrub Typhus.
    J Neurosci Rural Pract 2017 Jul-Sep;8(3):421-426
    All India Institute of Medical Sciences, New Delhi, India.
    Scrub typhus is caused by Orientia tsutsugamushi characterized by focal or disseminated vasculitis and perivasculitis which may involve the lungs, heart, liver, spleen and central nervous system. It was thought to have been eradicated from India. Recently it is being reported from many areas of India. Read More

    Neuroleptic malignant syndrome in the trauma intensive care unit: Diagnosis and management of a rare disease in a challenging population.
    Int J Crit Illn Inj Sci 2017 Apr-Jun;7(2):119-121
    Department of Surgery, Division of Trauma, Critical Care, and Burn, The Ohio State University, OH, USA.
    Neuroleptic malignant syndrome (NMS) is a life-threatening neurological disorder associated with the use of antipsychotic medications. Many of its classic signs, such as fever and altered mental status, are nonspecific in trauma intensive care unit (ICU) patients, and its rarity makes it a difficult diagnosis in this population. However, delays in treatment can be costly both in terms of hospital resources and patient outcomes. Read More

    Success of tardive electroconvulsive therapy sessions after loxapine-induced malignant syndrome in the context of very poor metabolisation.
    Therapie 2017 Dec 29;72(6):643-647. Epub 2017 May 29.
    Toxicology laboratory, department of medical pharmacology and toxicology, Lapeyronie hospital, CHRU of Montpellier, 34295 Montpellier cedex 5, France; University of Montpellier, 34000 Montpellier, France; UMR 5569 hydrosciences, 34090 Montpellier, France.
    We report the success of tardive electroconvulsive therapy in a case of loxapine malignant syndrome with catatonia. Loxapine and its metabolites were measured in biological samples by liquid chromatography coupled to tandem mass spectrometry. Genes were studied by sequencing and quantitative polymerase chain reaction (PCR). Read More

    Olanzapine-induced Neuroleptic Malignant Syndrome.
    Indian J Psychol Med 2017 May-Jun;39(3):364-365
    Department of Psychiatry, Institute of Psychiatry, Kolkata, West Bengal, India.
    Neuroleptic malignant syndrome (NMS) is a life-threatening adverse effect usually seen with typical antipsychotic drugs. Rarely, NMS can occur with atypical antipsychotics also. A 19-year-old male diagnosed as a case of acute and transient psychotic disorder developed NMS, following the treatment with an atypical antipsychotic, olanzapine 20 mg/day. Read More

    Common toxidromes in movement disorder neurology.
    Postgrad Med J 2017 Jun 7;93(1100):326-332. Epub 2016 Oct 7.
    Department of Neurology, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK.
    Background: Physicians can come across patients who are exposed to certain prescription drugs or toxins that can result in adverse effects and complications which have high rates of morbidity and mortality.

    Objective: To summarise the key clinical features and management of the common movement disorder toxidromes relevant to physicians (with an interest in neurology).

    Methods: We searched PUBMED from 1946 to 2016 for papers relating to movement toxidromes and their treatment. Read More

    Olanzapine-Induced Neuroleptic Malignant Syndrome.
    Iran J Med Sci 2017 May;42(3):306-309
    Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Department of Psychiatry, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
    Neuroleptic malignant syndrome (NMS) is a rare but life-threatening idiosyncratic side effect resulting from neuroleptic drugs. NMS mainly occurs in patients treated with high-potency typical antipsychotics, but rarely caused by atypical antipsychotics. Although NMS is less common with atypical antipsychotic, but it seems that its incidence is rising due to increased administration of such drugs. Read More

    Leukodystrophy Presenting as Hyperactivity and Bipolarity with Uncommon Adverse Drug Reaction.
    Indian J Psychol Med 2017 Mar-Apr;39(2):202-204
    Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
    Leukodystrophy is a group of demyelinating neurodegenerative diseases of brain with varied presentation and multiple etiologies. Prognosis is predominantly dismal. Misdiagnosis and wrong treatment are common in this group of rare neurological disorders, especially when it presents with psychiatric symptoms. Read More

    Severe hyponatremia in a patient with schizophrenia associated with prolonged consciousness disturbance.
    CEN Case Rep 2017 May 18;6(1):5-11. Epub 2016 Oct 18.
    Department of Nephrology and Hypertension, Faculty of Blood Purification, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan.
    Hyponatremia presents with various central nervous system symptoms during its course and treatment. We treated a patient who presented with a prolonged consciousness disorder and was suspected of having complications of neuroleptic malignant syndrome and osmotic demyelination syndrome (ODS) during the treatment for his hyponatremia, which was caused by syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The patient was a 30-year-old Japanese man who had been under treatment for schizophrenia. Read More

    The Role of Amantadine Withdrawal in 3 Cases of Treatment-Refractory Altered Mental Status.
    J Psychiatr Pract 2017 May;23(3):191-199
    FRYML, WILLIAMS, PELIC, FOX, SAHLEM, ROBERT, and SHORT: Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC REVUELTA: Department of Neurology and Neurosciences, Medical University of South Carolina, Charleston, SC.
    Amantadine, which was originally developed as an antiviral medication, functions as a dopamine agonist in the central nervous system and consequently is utilized in the treatment of Parkinson disease, drug-induced extrapyramidal reactions, and neuroleptic malignant syndrome. For reasons that are not entirely understood, abrupt changes in amantadine dosage can produce a severe withdrawal syndrome. Existing medical literature describes case reports of amantadine withdrawal leading to delirium, which at times has progressed to neuroleptic malignant syndrome. Read More

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