Neuroleptic Syndrome/serotonin Syndrome Flashcards
What is neuroleptic malignant syndrome?
Rare but dangerous condition which is seen in patients taking antipsychotic medication
It carries a mortality of up to 10% and can also occur with atypical antipsychotics
It can also occur with dopaminergic drugs- like levodopa for parkinsons disease
Usually occurs when the drug is suddenly stopped or the dose is reduced
What is the pathophysiology behind neurlopetic malignant syndrome?
The pathophysiology is unknown but one theory is that the dopamine blockade induced by antipsychotics triggers massive glutamate release and subsequent neurotoxicity and muscle damage.
What is the presentation of neuroleptic malignant syndrome?
It occurs within hours to days of starting an antipsychotic
Typical features..
- pyrexia
- muscle rigidity
- autonomic symptoms (hypertension, tachycardia, tachypnoea)
- agitated delirium with confusion
What would be found on ix of neuroleptic malignant syndrome?
A raised creatine kinase is present in most cases. Acute kidney injury (secondary to rhabdomyolysis) may develop in severe cases. A leukocytosis may also be seen
What is the management of neuroleptic malignant syndrome?
stop antipsychotic
patients should be transferred to a medical ward if they are on a psychiatric ward and often they are nursed in intensive care units
IV fluids to prevent renal failure
dantrolene may be useful in selected cases
thought to work by decreasing excitation-contraction coupling in skeletal muscle by binding to the ryanodine receptor, and decreasing the release of calcium from the sarcoplasmic reticulum
bromocriptine, dopamine agonist, may also be used
What is serotonin syndrome, what presentation does it cause?
Caused by SSRIS, MAOIS, ecstasy, novel psychoactive stimulants
Faster onset (hours)
There will be increased reflexes, clonus and dilated pupils
How do you treat serotonin syndrome?
Cyproheptadine
Chlorpromazine
