Neuroleptic Malignant Syndrome

Question 1

Neuroleptic malignant syndrome - what is it characterised by?

Answer 1

Neuroleptic malignant syndrome, which is characterised by altered mental status (i.e. confusion), fever, muscular rigidity, and dysautonomia (i.e. autonomic instability).

Question 2

Which of the following fetal complications is lithium most strongly associated?

A	Neural tube defects
B	Cleft palate
C	Hydrocephalus
D	Tetralogy of Fallot
E	Epstein anomaly

Answer 2

The use of lithium during the first trimester is associated with an increased risk of cardiac malformations including Epstein’s anomaly.

Question 3

Epstein’s anomaly describes a right ventricular outflow tract abnormality due to downward displacement of the tricuspid valve. Its development has been associated with the use of … during the first trimester

Answer 3

Epstein’s anomaly describes a right ventricular outflow tract abnormality due to downward displacement of the tricuspid valve. Its development has been associated with the use of lithium during the first trimester. However, the magnitude of the association is probably much smaller than originally proposed in the early 1970’s. Therefore, in patients with well controlled bipolar disorder on lithium therapy, a risk/benefit discussion should take place between clinician and patient about continuation of therapy when attempting to become pregnant.