Serotonin syndrome and neuroleptic malignant syndrome Flashcards
Triad of symptoms seen in serotonin syndrome
Neuromuscular abnormalities - myoclonus, clonus
Altered mental state
Autonomic dysfunction
Time from starting or increasing a serotonergic drug to developing symptoms of serotonin syndrome
Within 24 hours
Vital signs seen in serotonin syndrome
HTN
Tachycardia
Tachypnoea
Hyperthermia >40 degrees
Neurological and psychiatric features of serotonin syndrome
Variable mental state - agitation to coma Increased muscle tone especially in legs Hyperreflexia Clonus Dilated pupils
Treatment for serotonin syndrome
Withdrawal of causative agent Supportive care 5HT2A antagonist e.g. cyproheptadine Benzodiazepines Atypical antipsychotics Paralysis and intubation in severe cases
Vital signs seen in neuroleptic malignant syndrome
HTN
Tachycardia
Tachypnoea
Hyperthermia >40 degrees
Neurological and behavioural features of neuroleptic malignant syndrome
Lead pipe rigidity in all limbs Confusion Fluctuating consciousness Hyporeflexia Normal pupils
GI feature of serotonin syndrome
Diarrhoea
High risk combinations for serotonin syndrome
SSRI and MAOI SSRI and RIMA SSRI and TCA SSRI and SNRI SSRI and lithium SSRI and l-tryptophan TCA and MAOI
Blood test results seen with neuroleptic malignant syndrome
Raised WCC
Raised CK
Deranged LFTs
Raised myoglobin
Proposed mechanisms causing neuroleptic malignant syndrome
Dopamine blockade at the hypothalamus causing hyperthermia
Calcium uptake into the muscles causing rigidity
Mortality rate for neuroleptic malignant syndrome
20%
Patient risk factors for developing neuroleptic malignant syndrome
Young age Male Psychosis Psychomotor retardation Intellectual disability Dehydration Previous NMS Hyperthyroidism Alcoholism Parkinson's disease
Drug related risk factors for developing neuroleptic malignant syndrome
Recent or rapid antipsychotic dose change
First generation antipsychotics
Sudden withdrawal of anticholinergic agents
Antipsychotic polypharmacy
Number of days antipsychotics should be stopped for following neuroleptic malignant syndrome
At least 5 days