Psych - Neuroleptic Malignant Syndrome Flashcards

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1
Q

What is NMS?

A
  • Rare, dangerous condition in patients taking antipsychotics.
  • 10% mortality, usually occurs with atypical antipsychotics or dopaminergic drugs for Parkinson’s disease (usually when drug is stopped suddenly)
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2
Q

What is the pathophysiology of NMS?

A
  • Unknown
  • Theory is that the dopamine blockages induced by antipsychotics triggers a massive glutamate release and there is subsequent neurotoxicity and muscle damage
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3
Q

When does NMS occur? What are the features?

A

-Within hours of starting an antipsychotic

PC

  • Pyrexia
  • Muscle rigidity
  • Autonomic lability: HTN, tachycardia and tachypnea
  • Agitated delirium with confusion
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4
Q

What are important Ix and Ex finding for NMS?

A

Investigations

  • Raised creative kinase
  • AKI (secondary to rhabdomyolysis)
  • Leukocytosis

Examination

  • Slower onset (hours-days)
  • Hyporeflexia
  • Lead pipe rigidity
  • Normal pupils
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5
Q

What is the management for someone with NMS?

A
  • Stop antipsychotic
  • Transfer patient to a medical ward if they are on psych ward
  • IV fluids to prevent renal failure
  • Dantrolene: thought to work by decreasing excitation-contraction coupling in the skeletal muscle by binding to the ryanodine receptor and decreasing the release of calcium from sarcopasmic reticulum
  • Bromocriptine: dopamine agonist
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