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Pharmacopsychiatry 2002; 35(3): 119-121
DOI: 10.1055/s-2002-31518
Case Report
© Georg Thieme Verlag Stuttgart · New York

Neuroleptic Malignant Syndrome due to Atypical Neuroleptics: Three Episodes in One Patient

R.  Bottlender, M.  Jäger, E.  Hofschuster, P.  Dobmeier, H.-J.  Möller
  • 1Department of Psychiatry, Ludwig-Maximilians-University, Munich
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Publication History

9. 10. 2000

22. 10. 2001

Publication Date:
23 May 2002 (online)

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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.

References

  • 1 Addonizio G, Susman V L, Roth S D. Symptoms of neuroleptic malignant syndrome in 82 consecutive inpatients.  Am J Psychiatry. 1986;  143 1587-1590
    PubMedGoogle Scholar
  • 2 American Psychiatric Association .Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition. Washington D.C. 1994
    Google Scholar
  • 3 Anderson E S, Powers P S. Neuroleptic malignant Syndrome Associated With Clozapine Use.  J Clin Psychiatry. 1991;  52 102-104
    PubMedGoogle Scholar
  • 4 Bajjoka I, Patel T, O'Sullivan T. Risperidone-induced neuroleptic malignant syndrome.  Ann Emerg Med,. 1997;  30 698-700
    PubMedGoogle Scholar
  • 5 Blumer D. Catatonia and the neuroleptics: psychobiologic significance of remote and recent findings.  Compr Psychiatry. 1997;  38 (4) 193-201
    CrossrefPubMedGoogle Scholar
  • 6 Corrigan F M, Coulter F. Neuroleptic malignant syndrome, amitriptyline and thioridazine.  Biol Psychiatry. 1988;  23 320-321
    CrossrefPubMedGoogle Scholar
  • 7 DasGupta K, Young A. Clozapine-Induced Neuroleptic Malignant Syndrome.  J Clin Psychiatry. 1991;  52 105-107
    PubMedGoogle Scholar
  • 8 Eikmeier G, Muszynski K, Berger M, Gastpar M. High-dose trimipramine in acute schizophrenia. Preliminary results of an open trial.  Pharmacopsychiatry. 1990;  23 (5) 212-214
    PubMedGoogle Scholar
  • 9 Fink M. Toxic Serotonin Syndrome or Neuroleptic Malignant Syndrome.  Pharmacopsychiat. 1996;  29 159-161
    PubMedGoogle Scholar
  • 10 Gurrera R J. Sympathoadrenal hyperactivity and the etiology of neuroleptic malignant syndrome.  Am J Psychiatry. 1999;  156 169-180
    PubMedGoogle Scholar
  • 11 Hegerl U, Bottlender R, Gallinat J. et al . The serotonin syndrome scale: first results on validity.  Eur Arch Psychiatry Clin Neurosci. 1998;  248 96-103
    CrossrefPubMedGoogle Scholar
  • 12 Iwahashi K. CYP2D6 genotype and possible susceptibility to the neuroleptic malignant syndrome.  Biol Psychiatry. 1994;  36 781-782
    CrossrefPubMedGoogle Scholar
  • 13 Karagianis J L, Phillips L C, Hogan K P. et al . Clozapine-associated neuroleptic malignant syndrome: two new cases and a review of the literature.  Ann-Pharmacother. 1999;  33 623-630
    PubMedGoogle Scholar
  • 14 Kawanishi C, Shimoda Y, Fujimaki J, Onishi H, Suzuki K, Hanihara T, Sugiyama N, Kosaka K. Mutation involving cytochrome P450IID6 in two Japanese patients with neuroleptic malignant syndrome.  J Neurol Sci. 1998;  160 (1) 102-104
    PubMedGoogle Scholar
  • 15 Kern J L, Cernek P K. Delayed risperidone-induced neuroleptic malignant syndrome.  Ann Pharmacother. 1996;  30 (3) 300
    PubMedGoogle Scholar
  • 16 Lee M S, Lee H J, Kim L. A case of delayed NMS induced by risperidone.  Psychiatr Serv. 2000;  51 (2) 254-255
    CrossrefPubMedGoogle Scholar
  • 17 Merriam A E. Withdrawal NMS after drug treatment.  Biol Psychiatry. 1988;  24 (3) 368-369
    CrossrefPubMedGoogle Scholar
  • 18 Miller D D, Sharafuddin J A, Kathol R G. A Case of Clozapine-Induced Neuroleptic Malignant Syndrome.  J Clin Psychiatry. 1991;  52 99-101
    PubMedGoogle Scholar
  • 19 Miyaoka H, Kamijima K. Encephalopathy during amitriptyline therapy: are neuroleptic malignant syndrome and serotonin syndrome spectrum disorders?.  Int Clin Psychopharmacol. 1995;  10 265-267
    PubMedGoogle Scholar
  • 20 Newman M, Adityanjee , Jampala C. Atypical neuroleptic malignant syndrome associated with risperidon treatment (letter).  Am J Psychiatry. 1997;  154 1475
    PubMedGoogle Scholar
  • 21 Pope H G, Keck P E , McElroy S L. Frequency and presentation of neuroleptic malignant syndrome in a large psychiatric hospital.  Am J Psychiatry. 1986;  143 1227-1233
    PubMedGoogle Scholar
  • 22 Ram A, Cao Q, Keck P E, Pope H G, Otani K, Addonizio G, McElroy S L, Kaneko S, Redlichova M, Gershon E S, Gejman P V. Structural change in dopamine D2 receptor gene in a patient with neuroleptic malignant syndrome.  Am J Med Genet. 1995;  60 228-230
    CrossrefPubMedGoogle Scholar
  • 23 Reznik I, Volchek L, Mester R, Kotler M, Sarova-Pinhas I, Spivak B, Weizman A. Myotoxicity and neurotoxicity during clozapine treatment.  Clin Neuropharmacol. 2000;  23 276-280
    PubMedGoogle Scholar
  • 24 Shaley A, Munitz H. The Neuroleptic Malignant Syndrome. Agent and host interaction.  Acta Psychiatr. Scand1986;  73 337
    PubMedGoogle Scholar
  • 25 Sharma R, Trappler B, Ng Y K, Leeman C P. Risperidone-induced neuroleptic malignant syndrome.  Ann Pharmakother. 1996;  30 775-778
    PubMedGoogle Scholar
  • 26 Singer S, Richards C, Boland R J. Two cases of risperidone-induced neuroleptic malignant syndrome (letter).  Am J Psychiatry. 1995;  152 1234
    PubMedGoogle Scholar
  • 27 Spivak B, Weizman A, Wolovick L. et al . Neuroleptic malignant syndrome during abrupt reduction of neuroleptic treatment.  Acta Psychiatr Scand. 1990;  81 168-169
    PubMedGoogle Scholar
  • 28 Stanilla J K, de Leon J, Simpson G M. Clozapine withdrawal resulting in delirium with psychosis: a report of three cases.  J Clin Psychiatry. 1997;  58 252-255
    PubMedGoogle Scholar
  • 29 Sternbach H. The serotonin syndrome.  Am J Psychiatry. 1991;  148 705-713
    PubMedGoogle Scholar

Ronald Bottlender, MD 

Psychiatrische Klinik der Ludwig-Maximilians-Universität

Nussbaumstr. 7


80336 München

Germany

Phone: +49-89-5160-5751

Fax: +49-89-5160-4749

Email: bottlend@psy.med.uni-muenchen.de

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