41. Bipolar Noise - News - Neuroleptic Malignant Syndrome Atypical neuroleptic malignant syndrome Associated With Olanzapine.from Pharmacotherapy. Roy R. Reeves, DO, Ph.D., Raphael A. Torres http://www.angelfire.com/fl5/bipolarnoise/News/NeurolepticMalignantSyndrome1.htm

Atypical Neuroleptic Malignant Syndrome Associated With Olanzapine from Pharmacotherapy Roy R. Reeves, D.O., Ph.D., Raphael A. Torres, M.D., Vincent Liberto, M.D., Roy H. Hart, M.D. Abstract and Introduction Abstract Neuroleptic malignant syndrome (NMS) is a potentially life-threatening adverse effect of antipsychotic agents. It generally is characterized by fever, altered mental status, rigidity, and autonomic dysfunction. A 53-year-old man developed NMS without rigidity while taking olanzapine. Such atypical cases may support either a spectrum concept of NMS or the theory that NMS secondary to atypical antipsychotics differs from that caused by conventional neuroleptics. More flexible diagnostic criteria than currently mandated by the the Diagnostic and Statistical Manual of Mental Disorders, Fourth Revision, may be warranted. Introduction Neuroleptic malignant syndrome (NMS) is an uncommon side effect of antipsychotic drugs, usually characterized by fever, altered mental status, rigidity, and autonomic dysfunction. The pathophysiology of NMS is not fully understood. Reduction in dopaminergic activity secondary to neuroleptic-induced dopamine blockade is considered the chief mechanism.[1] This syndrome was first described in 1960 during clinical trials with haloperidol.[2] Since that time, NMS has been associated with virtually all dopamine-blocking agents. Because many atypical antipsychotic agents have weaker dopamine blockade and lower rates of extrapyramidal side effects than conventional antipsychotic agents,[3] it has been suggested that atypical antipsychotic agents are less likely to cause NMS. However, this remains unproven, and cases of NMS associated with clozapine, risperidone, olanzapine, and quetiapine have been reported.[4-27]

42. Bombay Hospital Journal - Case Reports - Incipient Neuroleptic INCIPIENT neuroleptic malignant syndrome (Report of 2 Cases and a Review). CSFwas normal. Incipient neuroleptic malignant syndrome was suspected. http://www.bhj.org/journal/1998/4001_jan/cr_153.htm

43. Nature Publishing Group Correspondence. neuroleptic malignant syndrome following BMT. MEDLINE. 3 NaganumaH, Fujii L. Incidence and risk factors in neuroleptic malignant syndrome. http://www.nature.com/cgi-taf/DynaPage.taf?file=/bmt/journal/v29/n9/full/1703532

44. Nature Publishing Group Case report. neuroleptic malignant syndrome following autologous peripheral bloodstem cell transplantation. neuroleptic malignant syndrome; autotransplant. http://www.nature.com/cgi-taf/DynaPage.taf?file=/bmt/journal/v21/n4/abs/1701093a

45. ClinicalTrials.gov - Linking Patients To Medical Research Search Query Details. No studies were found for neuroleptic malignant syndrome ALLFIELDS. IndividualTerms, Count. neuroleptic malignant syndrome , None. http://www.clinicaltrials.gov/search/term=Neuroleptic Malignant Syndrome

46. Neuroleptic Malignant Syndrome Information Page Diseases Database neuroleptic malignant syndrome Information Page. Neuroleptic malignantsyndrome Goneuroleptic malignant syndrome specific sites. http://www.diseasesdatabase.com/sieve/item1.asp?glngUserChoice=8968

47. Neuroleptic Malignant Syndrome neuroleptic malignant syndrome. Roy Perlis. A. Central features. 1. Delirium.2. Rigidity (“lead pipe”). 3. Fever. 4. Autonomic instability http://www.mghmclean.org/residents/handbk/part2b/nms.htm

Neuroleptic Malignant Syndrome Roy Perlis A. Central features 1. Delirium 2. Rigidity (“lead pipe”) 3. Fever 4. Autonomic instability (tachycardia, diaphoresis, labile BP) B. Laboratory values (though primarily a clinical diagnosis!) 1. Elevated CPK (MM fraction) 2. Elevated WBC (not always) C. Risk factors 1. Most often seen with typical neuroleptics. 2. Nonetheless, also reported with atypicals including clozapine. 3. Lithium may increase risk. D. Differential diagnosis 1. Catatonia (should not be febrile) 2. Delirium (diaphoretic in NMS, dry skin in anticholinergic delirium) 3. Severe parkinsonism (should not have delta MS unless infxn) E. Treatment 1. Discontinue neuroleptic 2. Pharmacologic options dantrolene or bromocriptine benzodiazepines 3. Supportive management hydration antipyretics monitor vitals, cardiac rhythm follow for rhabdomyolysis, renal failure, arrhythmias, hypoTN source : Hyman SE and Tesar GE (1994) Manual of Psychiatric Emergencies. Little, Brown.

48. -Neuroleptic Malignant Synd WARNING neuroleptic malignant syndrome Clinical. neuroleptic malignant syndromeis the rarest of the neuroleptic induced movement disorders. http://endoflifecare.tripod.com/juvenilehuntingtonsdisease/id279.html

Juvenile-HD HOME INDEX Page Tools For Viewing 10 The Most Commonly Asked Questions ... -Mood Stabilizers: ASK 3 Questions -Neuroleptic Malignant Synd WARNING -Olanzipine-Risperidone/blood tests -Celexa/Luvox/Paxil/Prozac/Zoloft Sertraline ~Zoloft -Spasticity Meds/Treatments ... GUESTBOOK -Neuroleptic Malignant Synd WARNING INDEX Page Drug Induced Movement Disorders NEUROLEPTIC MALIGNANT SYNDROME Clinical Neuroleptic malignant syndrome is the rarest of the neuroleptic induced movement disorders. It is the most serious and represents a neurologic emergency in most cases. It has now been reported to occur with all drugs that effect the central dopaminergic system (including dopamine agonists and levodopa). There's an isolated report of neuroleptic malignant syndrome in a patient on a trycyclic medication. It is likely an idiosyncratic reaction and patients can, if needed, be given the same agent again without recurrence. It is estimated that 0.5-1% of patients exposed to neuroleptics will develop this syndrome. Most patients will develop it shortly after initial exposure and 90% within two weeks of starting the neuroleptic. It can occur with all the neuroleptics but haldol and trifluperazine are the most common. It has also been seen with clozapine and metoclopramide. The classic triad involves the autonomic nervous system ( fever in 100%), the extrapyramidal system (

49. Neuroleptic Malignant Syndrome ¤§µo¥Í»PªvÀø The summary for this Chinese (Traditional) page contains characters that cannot be correctly displayed in this language/character set. http://www.vghtpe.gov.tw/~pharm/doc/issue/drug/8404_1.htm

50. Serotonin Syndrome 07/00 The signs and symptoms of serotonin syndrome are very similar to thoseof neuroleptic malignant syndrome and malignant hyperthermia. http://www.poison.org/case/0007.asp

Poison Pearls and Perils A Bulletin from the National Capital Poison Center Vol. 6, No. 3 July 2000 by Cathleen Clancy, MD, Medical Toxicologist Case: A 63-year-old man with insulin-dependant diabetes mellitus awoke from a sound sleep with difficulty controlling his extremities. Upon arrival at the ED one hour later, he was flushed, diaphoretic, confused, and had hyperreflexia and tachycardia. His extremities had myoclonus and increased tone. His rectal temperature was 104.5 B F. For many years he had been maintained on insulin, moexipril (ACE inhibitor), glucophage, and hydrochlorothiazide. He had been started on nefazodone (Serzone R ) 3 months prior to presentation. Four days before presentation the patient was also started on fluoxetine (Prozac R ). Therapy included cooling, lorazepam and supportive care. By the following day he was alert and afebrile, without a trace of muscle tremor. Does this man have three of the following symptoms; mental status changes, agitation, myoclonus, hyperreflexia, diaphoresis, tremor, diarrhea, incoordination, fever? Yes.

51. 617 - Neuroleptic Malignant Syndrome With Risperidone neuroleptic malignant syndrome with Risperidone. A 73year-old woman developedneuroleptic malignant syndrome after monotherapy with risperidone. http://www.accp.com/pharmacotherapy/Abs17_3/617.htm

Article Abstract for... Neuroleptic Malignant Syndrome with Risperidone Patrick P. Gleason, Pharm.D., and Rosemarie L. Conigliaro, M.D. Neuroleptic malignant syndrome is thought to be a result of dopamine D2 receptor blockade in the striatum of the basal ganglia. Risperidone, a benzisoxazole derivative antipsychotic, has high serotonin 5-HT2 receptor blockade and dose-related D2 receptor blockade. The high ratio is believed to impart the low frequency of extrapyramidal symptoms with risperidone at low dosages. With this low frequency of extrapyramidal symptoms, it was thought the frequency of neuroleptic malignant syndrome might also be lowered. A 73-year-old woman developed neuroleptic malignant syndrome after monotherapy with risperidone. The syndrome reversed after discontinuing risperidone and starting treatment with dantrolene and bromocriptine. It appears that the protection from extrapyramidal side effects observed with risperidone does not ensure protection from neuroleptic malignant syndrome. (Pharmacotherapy 1997;17(3):617-621)

52. P000216b - Neuroleptic Malignant Syndrome - Treatment neuroleptic malignant syndrome Treatment. 2/16/00 (Del Rio). Group Wednesday Residents. QuestionWhat is the best therapy for neuroleptic malignant syndrome? http://www.emory.edu/WHSCL/grady/amreport/litsrch99/p000216b.html

[litsrch99/page_header.html] Neuroleptic Malignant Syndrome - Treatment 2/16/00 (Del Rio) Group: Wednesday Residents RE: A 49-year-old incarcerated male with history of psychosis and recent haldol use. Question: What is the best therapy for Neuroleptic Malignant Syndrome? (Choices were taken from the search for "NMS - Without Fever") Unique Identifier: 92350912 Authors: Gratz SS. Levinson DF. Simpson GM. Institution: Department of Psychiatry, Medical College of Pennsylvania/EPPI, Philadelphia. Title: The treatment and management of neuroleptic malignant syndrome. [Review] [52 refs] Abstract: Unique Identifier: 91059150 Authors: Dalkin T. Lee AS. Institution: Department of Psychiatry, University Hospital, Queen's Medical Centre, Nottingham. Title: Carbamazepine and forme fruste neuroleptic malignant syndrome [see comments]. Source: British Journal of Psychiatry. 157:437-8, 1990 Sep. Abstract: A woman developed rigidity, autonomic instability and altered consciousness after taking an overdose of trifluoperazine and carbamazepine. A diagnosis of NMS was made despite the absence of fever, as carbamazepine might modify the presentation of NMS. Morning Report Emory University School of Medicine 1999 Edition Participating Faculty: Daniel Stephens MD / Donald Brady MD dbrady@emory.edu

53. P000216a - Neuroleptic Malignant Syndrome Without Fever neuroleptic malignant syndrome Without Fever. 2/16/00 (Del Rio). QuestionCan neuroleptic malignant syndrome (NMS) present without fever? 2 . http://www.emory.edu/WHSCL/grady/amreport/litsrch99/p000216a.html

[litsrch99/page_header.html] Neuroleptic Malignant Syndrome Without Fever 2/16/00 (Del Rio) Group: Wednesday Residents RE: A 49-year-old incarcerated male with history of psychosis and recent haldol use. Question: Can Neuroleptic Malignant Syndrome (NMS) present without fever? Unique Identifier: 94216672 Authors: Lev R. Clark RF. Institution: Department of Emergency Medicine, University of California, San Diego 92103-8676. Title: Neuroleptic malignant syndrome presenting without fever: case report and review of the literature. [Review] [48 refs] Source: Journal of Emergency Medicine. 12(1):49-55, 1994 Jan-Feb. Abstract: The case of a patient with neuroleptic malignant syndrome (NMS) and delayed fever is presented. The patient was on lithium and trilafon before presentation to the emergency department with altered sensorium, rigidity, drooling, and tachycardia. The patient remained afebrile for 9 hours in the emergency department. He responded to treatment involving discontinuation of neuroleptics and bromocriptine. Typically NMS presents with a tetrad of fever, rigidity, altered sensorium, and autonomic dysfunction. This case is an example of NMS with delayed fever. A review of the literature on neuroleptic malignant syndrome is also presented. [References: 48] Unique Identifier: 94216671 Authors: Totten VY. Hirschenstein E. Hew P.

54. Neuroleptic Malignant Syndrome - General Practice Notebook medical information from General Practice Notebook. neuroleptic malignantsyndrome. Malignant neuroleptic syndrome is a rare, potentially http://www.gpnotebook.co.uk/cache/-147521505.htm

neuroleptic malignant syndrome Malignant neuroleptic syndrome is a rare, potentially fatal idiosyncratic reaction occurring in response to neuroleptic drug therapy. It has been reported for haloperidol, chlorpromazine and flupenthixol decanoate. The syndrome lasts 5-10 days after the discontinuation of drug therapy during which time ITU support is necessary. There is no proven treatment though bromocriptine and dantrolene have been used. This syndrome can also occur in patients with Parkinson's disease following withdrawal of levodopa or dopamine antagonists or by the addition of lithium (2). Click here for more information...

55. Serotonin Syndrome And Neuroleptic Malignant Syndrome Serotonin syndrome and neuroleptic malignant syndrome. Fink M. Neurolepticmalignant syndrome and catatonia one entity or two? editorial. http://www.dr-bob.org/tips/split/Serotonin-syndrome-and-neu.html

Dr. Bob's Psychopharmacology Tips to Deutsch Italiano Portuguese Links Tips Babble Qx ... Support Serotonin syndrome and neuroleptic malignant syndrome Date: Tue, 19 Dec 1995 08:37:50 EST Subject: Toxic serotonin syndrome, NMS, and catatonia The inquiry about the serotonin syndrome reminded me that we had posted a story about a patient with recurrent depressive mood disorder who had received l-dopa, trazodone, and a single dose of nortriptyline after which she developed an acute syndrome of agitation, mutism, and diarrhea, followed by rigidity. On admission to a psychiatric ER, she was diagnosed with NMS and treated with lorazepam with some relief. As she had not received neuroleptics in many months, the diagnosis was changed to TSS toxic serotonin syndrome. She eventually received ECT and recovered to her usual euthymic inter-episode state. Two good recent references are: Sternbach H. The serotonin syndrome. [Review] American Journal of Psychiatry. 148 (6): 705-13, 1991 Jun. Comments: 1992 Mar, 149 (3): 411-2; 1992 Aug, 149 (8): 1116-7; 1993 Mar, 150 (3): 522. Braitberg G. Serotonin syndrome [letter]. Medical Journal of Australia. 160 (8): 527-8, 1994 Apr 18. Comment on: 1993 Nov 1, 159 (9): 624-6.

56. Collage Of Registered Psychiatric Nurses Of Manitoba neuroleptic malignant syndrome (NMS). Number 5. Bristow, Kohen D. 1996 NeurolepticMalignant Syndrome. British Journal of Hospital Medicine, Vol. 55, No. http://www.crpnm.mb.ca/nms.html

NEUROLEPTIC MALIGNANT SYNDROME (NMS) Definition and Causes of NMS A distinct form of drug induced dysregulation of the dopaminergic system related to: the dopamine antagonist properties of neuroleptic drugs or to the withdrawal of dopeminergic drugs from neurological patients (usually Parkinsonism). All neuroleptics have been implicated including Respiradol. High potency neuropleptics such as Haldol appear to carry more risk. Incidence of NMS Estimated that 1.0% patients treated with neuroleptics develop NMS (Carbone, 2000) . NMS can be fatal Deaths from NMS are primarily from renal failure or respiratory failure (e.g aspiration pneumonia, pulmonary emboli, acute tubular necrosis.) Mortality rate for NMS is estimated at 12% to 20% (Carbone, 2000). NMS Patients are also at risk for Rhabdomyolysis (destruction of skeletal muscle) renal failure disseminated intravascular coagulation pulmonary emboli cardiorespiratory arrest peripheral and muscle damage and rarely residual brain damage Factors which increase patient's risk for NMS *dehydration * organic brain syndromes * nutritional deficiencies exhaustion agitation catatonia mood disorders withdrawal states rapid escalation of medication dosage parenteral administration of medications Onset of NMS May develop dramatically within a few hours of administration or insidiously over several days. Has been reported to emerge after years of treatment.

57. Risperidone Induced Neuroleptic Malignant Syndrome Risperidone Induced neuroleptic malignant syndrome Risperidone Induced NeurolepticMalignant Syndrome A case report and review of the Literature. http://www.nyschp.org/the_pharmacist/sept97/risperid.html

Risperidone Induced Neuroleptic Malignant Syndrome: A case report and review of the literature Authors: First Author Roopali Sharma, Pharm.D Assistant Professor Adjunctive clinical instructor of department of medicine State University of New York at Brooklyn Brooklyn, NY Second Author Brian Trappler, M.D. Assistant Clinical Professor of Psychiatry State University of New York at Brooklyn Brooklyn, NY Third Author Yiu Kee NG, M.D. Clinical Assistant Instructor State University of NY at Brooklyn Brooklyn, NY Fourth Author Cavin Leeman, M.D. Professor of Clinical Psychiatry State University of NY at Brooklyn Brooklyn, NY Corresponding author: Roopali Sharma, Pharm.D. Address for reprints: Health Science center at Brooklyn 445 Lenox Rd., Box 36 Brooklyn, NY 11203 Phone: (718) 270-1527 Fax: (718) 270-3360 ABSTRACT OBJECTIVE: To describe a patient with neuroleptic malignant syndrome (NMS) induced by risperidone, an atypical antipsychotic and to review the available literature related to risperidone associated NMS. DATA SOURCE: Case report information was obtained from the resident physician and medical records. MEDLINE and

58. PD: Clozapine For Psychosis; Neuroleptic Malignant Syndrome Susceptibility Subject PD Clozapine for psychosis; neuroleptic malignant syndromesusceptibility, Date 4/14/1999. 1. Lowdose clozapine for the http://www.wemove.org/emove/article.asp?ID=43

59. NORD - National Organization For Rare Disorders, Inc. neuroleptic malignant syndrome. To purchase fulltext report ($7.50) Copyright1990, 1995 Synonyms of neuroleptic malignant syndrome No synonyms found. http://www.rarediseases.org/search/rdbdetail_abstract.html?disname=Neuroleptic M

60. Irish Medical Journal IMJ Home. neuroleptic malignant syndrome a diagnosis easily missedAuthor McDonough CM, Mangan B, Swift G, Sheehan John. A woman http://www.imj.ie/news_detail.php?nNewsId=2046&nVolId=60

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