neuroleptic malignant syndrome

Question 1

Neuroleptic malignant syndrome (NMS) is what?

Answer 1

a life-threatening idiosyncratic reaction to antipsychotic drugs

Question 2

Neuroleptic malignant syndrome has been associated with what?

Answer 2

virtually all neuroleptics, including newer atypical antipsychotics, as well as a variety of other medications that affect central dopaminergic neurotransmission.

Question 3

NMS

Answer 3

Neuroleptic malignant syndrome

Question 4

Neuroleptic malignant syndrome (NMS) can cause what reactions

Answer 4

fever, altered mental status, muscle rigidity, and autonomic dysfunction.

Question 5

Patients typically develop NMS within what time frame?

Answer 5

Hours or days after exposure to a causative drug, with most exhibiting symptoms within 2 weeks and nearly all within 30 days.

Question 6

Describe a typical clinical course

Answer 6

The clinical course typically begins with muscle rigidity followed by a fever within several hours of onset and mental status changes that can range from mild drowsiness, agitation, or confusion to a severe delirium or coma.

Question 7

Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition [DSM-IV]) Research Criteria for Neuroleptic Malignant Syndrome

Answer 7

A. Development of severe muscle rigidity and elevated temperature associated with the use of neuroleptic medication.
B. Two (or more) of the following:
 (1) Diaphoresis
 (2) Dysphagia
 (3) Tremor
 (4) Incontinence
 (5) Changes in level of consciousness ranging from confusion to coma
 (6) Mutism
 (7) Tachycardia
 (8) Elevated or labile blood pressure
 (9) Leukocytosis
(10) Laboratory evidence of muscle injury (eg, elevated CPK)
C. The symptoms in criteria A and B are not due to another substance or a neurological or other general medical condition.
D. The symptoms in criteria A and B are not better accounted for by a mental disorder.

Question 8

Signs of autonomic nervous system instability that frequently accompany NMS includes what?

Answer 8

ilabile blood pressure, tachypnea, tachycardia, sialorrhea, diaphoresis, flushing, skin pallor, and incontinence.

Question 9

Once symptoms appear, progression can be…

Answer 9

rapid and can reach peak intensity in as little as 3 days.

Question 10

Although muscle rigidity is the most frequently described motor sign, a large number of additional extrapyramidal motor findings have been reported including…

Answer 10

tremor, chorea, akinesia, and dystonic movements including opisthotonos, trismus, blepharospasm, and oculogyric crisis

Question 11

As well as tremor, chorea, akinesia, and dystonic movements including opisthotonos, trismus, blepharospasm, and oculogyric crisis, Other symptoms that have been associated with NMS include…

Answer 11

dysphagia, dyspnea, abnormal reflexes, mutism, and seizures

Question 12

The primary trigger of NMS is…

Answer 12

dopamine receptor blockade

Question 13

the standard causative agent is an…

Answer 13

antipsychotic.

Question 14

Potent typical neuroleptics such as haloperidol…

Answer 14

have been most frequently associated with NMS and thought to confer the greatest risk.

Question 15

Although atypical neuroleptics appear to have reduced the risk of developing NMS compared to typical neuroleptics, a significant number of cases have been reported with most atypical neuroleptics including…

Answer 15

risperidone, clozapine quetiapine, olanzapine

Question 16

Neuroleptic malignant syndrome has also been associated with nonneuroleptic agents with antidopaminergic activity such…

Answer 16

promethazine

Question 17

Diaphoresis?

Answer 17

sweating, especially to an unusual degree

Question 18

Dysphagia?

Answer 18

difficulty or discomfort in swallowing

Question 19

Leukocytosis?

Answer 19

increase in the number of white cells in the blood

Question 20

chorea

Answer 20

involuntary, irregular or unpredictable muscle movements

Question 21

akinesia

Answer 21

inability to perform a clinically perceivable movement

Question 22

dystonic movements

Answer 22

movement disorder that causes the muscles to contract involuntarily. This can cause repetitive or twisting movements

Question 23

oculogyric crisis?

Answer 23

Oculogyric Crisis (OGC) is a rare, acute dystonic reaction involving the extraocular muscles. OGC is most commonly described as the involuntary upward deviation of both eyes due to spasms and increased tone in the extraocular muscles.

Question 24

dysphagia?

Answer 24

difficulty or discomfort in swallowing, as a symptom of disease.

Question 25

opisthotonos?

Answer 25

Opisthotonos is a condition in which a person holds their body in an abnormal position. The person is usually rigid and arches their back, with their head thrown backward. If a person with opisthotonos lies on their back, only the back of their head and heels touch the surface they are on.

Question 26

trismus?

Answer 26

spasm of the jaw muscles, causing the mouth to remain tightly closed, typically as a symptom of tetanus.

Question 27

blepharospasm?

Answer 27

involuntary tight closure of the eyelids.

Question 28

dyspnea?