Along with the field of adult psychiatry, antipsychotic agents are increasingly used in the field of child and adolescent psychiatry. Although neuroleptic malignant syndrome (NMS) and rhabdomyolysis are rare complication associated with antipsychotic agent, clinicians should need to pay attention to all potential adverse drug reaction (ADR). Also, ADRs in child and adolescent could show different signs and symptoms compared with those in adult. In this case report, we present a case of NMS in a child which occurred shortly after the resolution of rhabdomyolysis which was induced by low-dose risperidone.
Adolescent Psychiatry ; Adolescent ; Adult ; Antipsychotic Agents ; Child ; Drug-Related Side Effects and Adverse Reactions ; Humans ; Neuroleptic Malignant Syndrome ; Rhabdomyolysis ; Risperidone

Neuroleptic malignant syndrome (NMS) is an uncommon but potentially lethal idiosyncratic reaction which may emerge in the aftermath of the treatments with neuroleptics demonstrating itself with the symptoms of altered consciousness, high fever, impaired autonomic functions, and muscle rigidity. Although various risk factors have been identified for NMS, its etiology is not completely known. The mortality and morbidity related with NMS could be reduced by early diagnosis, interruption of the neuroleptics used within a short period and aggressive treatment. Our case is different from general NMS cases due to lack of rigidity. A NMS case which developed within a short time in the aftermath of multiple antipsychotic use and wherein no rigidity was observed shall be discussed in this case report.
Antipsychotic Agents ; Consciousness ; Early Diagnosis ; Fever ; Mortality ; Muscle Rigidity ; Neuroleptic Malignant Syndrome ; Risk Factors

Neuroleptic malignant syndrome (NMS) is a life-threatening idiosyncratic reaction that usually occurs after the administration of antipsychotic drugs. Antidepressants, benzodiazepines, and antiepileptic drugs are also suggested to be associated with NMS. It is believed to result from a dopaminergic blockade in the central nervous system. NMS is manifested by hyperthermia, muscle rigidity, autonomic dysfunction, altered mental status, leukocytosis, and elevated serum creatinine phosphokinase. Valproate is commonly used in the treatment of many psychiatric and neurologic disorders. Valproate can precipitate NMS, especially when used with antipsychotic drugs concurrently. A 17-year-old male patient, who presented with fever, muscular rigidity, confusion, sweating, and tachycardia was admitted to the emergency room. He had been taking only valproate for the last two months for bipolar disorder. His laboratory analyses revealed raised serum hepatic enzymes, creatinine phosphokinase, and myoglobin levels. Considering fever, rigidity, autonomic dysfunction, cognitive alteration, and high creatinine phosphokinase levels, the patient was diagnosed with NMS. In this paper, we aim to discuss the association between valproate and NMS.
Adolescent* ; Anticonvulsants ; Antidepressive Agents ; Antipsychotic Agents ; Benzodiazepines ; Bipolar Disorder ; Central Nervous System ; Child ; Creatinine ; Emergency Service, Hospital ; Fever ; Humans ; Leukocytosis ; Male ; Muscle Rigidity ; Myoglobin ; Nervous System Diseases ; Neuroleptic Malignant Syndrome* ; Sweat ; Sweating ; Tachycardia ; Valproic Acid*

We present a case of 32-year-old male with profound mental retardation and autism spectrum disorder who had presented with seizures, rigidity and elevated creatine kinase and was initially diagnosed as neuroleptic malignant syndrome (NMS). The patient subsequently had a complicated clinical course, developing refractory status epilepticus, which lead to the eventual diagnosis of progressive encephalomyelitis with rigidity and myoclonus (PERM). We discuss the clinical similarities and differences between NMS and PERM, and highlight the need to consider alternative diagnoses when the clinical picture of NMS is atypical, particularly in this patient group where the history and clinical examination may be challenging.
Adult ; Autism Spectrum Disorder ; Autistic Disorder ; Creatine Kinase ; Diagnosis ; Encephalomyelitis* ; Humans ; Intellectual Disability ; Male ; Myoclonus* ; Neuroleptic Malignant Syndrome* ; Seizures ; Status Epilepticus

Neuroleptic malignant syndrome is a rare, but potentially life-threatening adverse event associated with the use of neuroleptic agents. We describe the case of a 47-year-old schizophrenic woman who was treated with clozapine for years. The patient developed acute renal failure with pulmonary edema, and underwent mechanical ventilation and hemodialysis.
Acute Kidney Injury ; Antipsychotic Agents ; Clozapine* ; Female ; Humans ; Middle Aged ; Neuroleptic Malignant Syndrome* ; Pulmonary Edema ; Renal Dialysis ; Respiration, Artificial ; Rhabdomyolysis

Neuroleptic malignant syndrome is a rare, but potentially life-threatening adverse event associated with the use of neuroleptic agents. We describe the case of a 47-year-old schizophrenic woman who was treated with clozapine for years. The patient developed acute renal failure with pulmonary edema, and underwent mechanical ventilation and hemodialysis.
Acute Kidney Injury ; Antipsychotic Agents ; Clozapine ; Female ; Humans ; Middle Aged ; Neuroleptic Malignant Syndrome ; Pulmonary Edema ; Renal Dialysis ; Respiration, Artificial ; Rhabdomyolysis

Neuroleptic malignant syndrome (NMS) is one of the most severe iatrogenic emergencies in clinical service. The symptoms including sudden consciousness change, critical temperature elevation and electrolytes imbalance followed by mutli-organ system failure were common in NMS. In addition to aggressive interventions with intravenous fluid resuscitation and antipyretics, several antidotes have been suggested to prevent further progression of the muscle damage. Dantrolene has been reported to be one of the most effective treatments for NMS. However, the adverse effects of dantrolene treatment for NMS have not yet been evaluated thoroughly. Here we report a young male patient with bipolar I disorder who developed NMS after rapid tranquilization with haloperidol. Dantrolene was given intravenously for the treatment of NMS. However, fever accompanied with local tenderness, hardness with clear border and swelling with heat over the patient's left forearm occurred on the sixth day of dantrolene treatment. Venous thromboembolism (VTE) over intravenous indwelling site at the patient's forearm was noted and confirmed by Doppler ultrasound. The patient's VTE recovered after heparin and warfarin thrombolytic therapy. To our knowledge, this is the first case report demonstrating the possible relationship between dantrolene use and VTE in a patient with antipsychotic treatment. Although the causal relationship and the underlying pathogenesis require further studies, dantrolene should be used with caution for patients with NMS.
Antidotes ; Antipyretics ; Consciousness ; Dantrolene* ; Electrolytes ; Emergencies ; Fever ; Forearm ; Haloperidol ; Hardness ; Heparin ; Hot Temperature ; Humans ; Male ; Neuroleptic Malignant Syndrome* ; Resuscitation ; Thrombolytic Therapy ; Ultrasonography ; Venous Thromboembolism* ; Warfarin

Neuroleptic malignant syndrome (NMS) is a rare but potentially lethal outcome caused by sudden discontinuation or dose reduction of dopaminergic agents. We report an extremely rare case of NMS after deep brain stimulation (DBS) surgery in a cerebral palsy (CP) patient without the withdrawal of dopaminergic agents. A 19-year-old girl with CP was admitted for DBS due to medically refractory dystonia and rigidity. Dopaminergic agents were not stopped preoperatively. DBS was performed uneventfully under monitored anesthesia. Dopaminergic medication was continued during the postoperative period. She manifested spasticity and muscle rigidity, and was high fever resistant to anti-pyretic drugs at 2 h postoperative. At postoperative 20 h, she suffered cardiac arrest and expired, despite vigorous cardiopulmonary resuscitation. NMS should be considered for hyperthermia and severe spasticity in CP patients after DBS surgery, irrespective of continued dopaminergic medication.
Anesthesia ; Cardiopulmonary Resuscitation ; Cerebral Palsy* ; Deep Brain Stimulation* ; Dopamine Agents ; Dystonia ; Female ; Fever ; Globus Pallidus* ; Heart Arrest ; Humans ; Muscle Rigidity ; Muscle Spasticity ; Neuroleptic Malignant Syndrome ; Postoperative Period ; Young Adult

Neuroleptic malignant syndrome (NMS) is a rare but potentially lethal outcome caused by sudden discontinuation or dose reduction of dopaminergic agents. We report an extremely rare case of NMS after deep brain stimulation (DBS) surgery in a cerebral palsy (CP) patient without the withdrawal of dopaminergic agents. A 19-year-old girl with CP was admitted for DBS due to medically refractory dystonia and rigidity. Dopaminergic agents were not stopped preoperatively. DBS was performed uneventfully under monitored anesthesia. Dopaminergic medication was continued during the postoperative period. She manifested spasticity and muscle rigidity, and was high fever resistant to anti-pyretic drugs at 2 h postoperative. At postoperative 20 h, she suffered cardiac arrest and expired, despite vigorous cardiopulmonary resuscitation. NMS should be considered for hyperthermia and severe spasticity in CP patients after DBS surgery, irrespective of continued dopaminergic medication.
Anesthesia ; Cardiopulmonary Resuscitation ; Cerebral Palsy ; Deep Brain Stimulation ; Dopamine Agents ; Dystonia ; Female ; Fever ; Globus Pallidus ; Heart Arrest ; Humans ; Muscle Rigidity ; Muscle Spasticity ; Neuroleptic Malignant Syndrome ; Postoperative Period ; Young Adult

We describe a case of recurrent, life-threatening, catatonic stupor, without evidence of any associated medical, toxic or mental disorder. This case provides support for the inclusion of a separate category of "unspecified catatonia" in the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) to be used to classify idiopathic cases, which appears to be consistent with Kahlbaum's concept of catatonia as a distinct disease state. But beyond the limited, cross-sectional, syndromal approach adopted in DSM-5, this case more importantly illustrates the prognostic and therapeutic significance of the longitudinal course of illness in differentiating cases of catatonia, which is better defined in the Wernicke-Kleist-Leonhard classification system. The importance of differentiating cases of catatonia is further supported by the efficacy of antipsychotics in treatment of this case, contrary to conventional guidelines.
Antipsychotic Agents ; Catatonia* ; Classification ; Diagnostic and Statistical Manual of Mental Disorders* ; Mental Disorders ; Neuroleptic Malignant Syndrome ; Schizophrenia ; Stupor