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Psych > neuroleptic malignant syndrome > Flashcards

neuroleptic malignant syndrome Flashcards

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1
Q

what is NMS

A

rare
can kill
happens with antipsychotics

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2
Q

incidence in antipsychotic tx

A

0.1-0.2%

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3
Q

typical vs atypical?

A

atypical less incidence

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4
Q

incidence increasing?

A

no decreasing

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5
Q

mortality NMS?

A 
20-38%
but declining (
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6
Q

RFs NMS

A
  1. young men
  2. high dose
  3. organic mental prob + LD
  4. alcohol + substance abuse
  5. low iron
  6. +ve FhX
  7. high potency antipsychotics
  8. IM admin
  9. agitation/behavioural prob
  10. switch/discontinuation/restart
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7
Q

cause of NMS?

A

low dopamine = due to sudden and massive blockade of post synaptic dopamine receptors

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8
Q

pathophysiology NMS?

A

less dopamine in hypothalamus + diencephalon = hyperthermia, catatonia + autonomic dysfunction

less dopamine in BG = EPSEs

less dopamine in mesocortical regions = clouded consciousness

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9
Q

is it just dopamine in NMS?

A

nope also serotonin, glutamate, GABA

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10
Q

how long til NMS happens?

A

can happen after one dose

higher risk with depot

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11
Q

clozapine NMS?

A

less tremor and rigidity

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12
Q

core symptoms of NMS?

A

hyperthermia
altered consciousness
EPSE
ANS probs

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13
Q

typical natural hx of NMS?

A
  1. starts after 2wks
  2. worse over 24-72 hours
  3. subsides in 14 days
  4. goes if stop drugs
  5. longer course with depot
  6. catatonia underdiagnosed
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14
Q

diagnostic criteria/

A

T >38*C + muscle rigidity + any 2 of:

  1. diaphoresis
  2. dysphagia
  3. tremor
  4. incontinence
  5. altered consciousness
  6. mutism
  7. tachyC
  8. labile BP
  9. raised CK
  10. leucocytosis
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15
Q

scales of NMS?

A

hynes vicker scale

francis yakoub scale

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16
Q

ix for NMS?

A

CK - raised in most
leucocytosis
myoglobinuria - AKI
secondary features

17
Q

what are the secondary features of NMS?

A 
raised serum aldolase
raised LDH
raised transaminases
hypoxia
met acidosis
low platelets 
DIC
electrolyte probs
deranged coag
18
Q

tx for NMS

A 
stop drug
supportive
dopamine agonist
muscle relaxant
benzos
\+/- ECT
19
Q

supportive measures?

A
  1. symptomatic management
  2. tx in emergency setting
  3. tx hyperthermia - improved outcome
  4. no physical restraint
  5. consider dialysis
20
Q

dopamine agonists

A
  1. bromocriptine PO or NGT

others: levodopa, apomorphine, amantadine

21
Q

dose bromocriptine?

A

60mg OD

22
Q

caution bromocriptine?

A
  1. can worsen psychosis
  2. avoid in serotonin syndrome
  3. avoid if have used MAOIs prior to sx onset
23
Q

muscle relaxant?

A
  1. dantrolene
  2. good for malignant hyperthermia
  3. IV
  4. don’t use alone
24
Q

how does dantrolene work?

A

inhibits ionised ca++ release which causes muscle relaxation and less fever/rigidity

25
Q

benzos in NMS?

A

lorazepam
diazepam
GABA-mimetic + increase dopaminergic function in BG

control agitation

26
Q

anticholinergics in NMs

A

NO as they inhibit sweating and worsen it

27
Q

ECT in NMS?

A

effective, safe

esp if affective or catatonic components

28
Q

px

A
  1. COD often from cardiac or resp arrest
  2. hypertheria >39.5 is poor px
  3. DIC is ominous

Psych (23 decks)

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