By Peter M. Haddad, Serdar Dursun, Bill Deakin
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Additional info for Adverse syndromes and psychiatric drugs: a clinical guide
In MH body temperature rises over minutes following the administration of anaesthetic agents. In contrast in NMS fever rises over hours and sometimes over a period of 24–48 hours and there is no relationship to anaesthetic agents. MH has a strong genetic component related to chromosome 19 and about 80 per cent of family members are susceptible to MH. The pathogenesis is though to relate to a defect in the cell membrane of muscle that leads to increased intracellular calcium and severe muscle contractions.
Creatine phosphokinase levels usually elevated. qxd 5/5/04 5:33 PM Page 33 NEUROLEPTIC MALIGNANT SYNDROME Management Discontinue all psychotropic medication on suspicion of NMS. e. systemic infections. Benzodiazepines, bromocriptine, dantrolene and possibly electroconvulsive therapy may be helpful in individual patients. Further reading Bristow M and Kohen D (2002). Predicting the effects of re-challenge with antipsychotics following NMS: A review of cases from Neuroleptic Malignant Syndrome database.
Estimate studies of recurrence vary from 1 per cent (Pope et al. 1991) to 43 per cent (Susman and Addonizio 1988). Premature reintroduction of neuroleptics in cases where the original episode of NMS has not completely resolved poses the greatest risk of recurrence. Rapid and dramatic dosage increment lead to more episodes of NMS (Shalev and Munitz 1986). Rechallenge Most NMS patients encountered in psychiatric practice have a diagnosis of severe mental illness and an episode of acute exacerbation at the time they develop NMS.
Adverse syndromes and psychiatric drugs: a clinical guide by Peter M. Haddad, Serdar Dursun, Bill Deakin