Neuroleptic malignant syndrome, SS syndrome

Question 1

NMS onset

Answer 1

Longer than SS - 1-7 days

Question 2

What do both NMS and SS cause

Answer 2

Severe autonomic dysfunction -> hyperthermia, HPTN, tachycarida
Neuro abnoramlities

Question 3

Who is often predisposed to NMS

Answer 3

Lewy body dementia patients - v sensitive to antipsychotics

Question 4

What movements is NMS ass with

Answer 4

Hyperreflexia, lead pipe rigidity

Question 5

Symptoms of serotnin syndrome

Answer 5

Abrupt <1 dya
Hyperreflexia
Increased tone and clonus
Dilated pupils
Hyperactive bowel sounds
Serotonergic drugs eg SSRIs, SNRIs, tramadol, cocaine

Question 6

Cause of NMS

Answer 6

Dopamine antagonists eg anti-psychotics, metoclopramide
OR sudden stopping of dopamineic drugs eg levodopa

Question 7

Medical Mangement of NMS if severe

Answer 7

Bromocritpine - dopamine agonist + dantrolene (muscle relaxant)

Question 8

Medical mangement Serotonin syndrome

Answer 8

Benzodiazapines

Question 9

Supportive management for NMS and SS

Answer 9

Stop offending drug
IV fluids, cooling, addressing any further metabolic or electolyte abnormalitites

Question 10

Risk factors for NMS/SS

Answer 10

Rapid titration
Dehydraton
Concurrent illness Prev episodes
Gentetuc

Question 11

Investigations for NMS

Answer 11

Raised CK
AKI if severe
Leukocytosis