“Ms. A,” a 25-year-old woman with paranoid schizophrenia, presented with an acute psychotic episode after having stopped taking her medication. She reported auditory hallucinations and was noted to be disheveled and to have loud, pressured speech, disorganization of thought processes, and persecutory delusions. Over a 10-hour period in the emergency department, she received two intramuscular in...

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The neuroleptic malignant syndrome is a rare, potentially fatal, adverse reaction to neuroleptic drugs characterised by severe rigidity, high temperature and autonomic dysfunction. In the light of the hypothesized pathophysiology of this condition, a rational approach to the management of patients presenting with temperature and rigidity is provided. The aims of this approach are three-fold: to...

This is a case of a 16-year-old male with a history of attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), obsessive compulsive disorder (OCD), and bipolar disorder (BD) who presented to the emergency department with hypertension, tachycardia, rigidity, and altered mental status 2 months after the initiation of olanzapine. Symptoms were most consistent with Neu...

INTRODUCTION A rare side effect of antipsychotic medication is neuroleptic malignant syndrome, mainly characterized by hyperthermia, altered mental state, haemodynamic dysregulation, elevated serum creatine kinase and rigor. There may be multi-organ dysfunction including renal and hepatic failure as well as serious rhabdomyolysis, acute respiratory distress syndrome and disseminated intravascul...

We report a case of severe neuroleptic malignant syndrome with hyperthermia, rhabdomyolysis and hepatic failure where we applied endovascular cooling in order to reverse hyperthermia. After rapid normalization of core temperature at 37.5 degrees C, the patient's condition improved and CK levels dropped. However, upon withdrawl of endovascular temperature control there was a relapse. This is the...

Antipsychotic and antidepressant are often used in combination for the treatment of neuropsychiatric disorders. The concomitant use of antipsychotic and/or antidepressant with drugs that may interact can lead to rare, life-threatening conditions such as serotonin syndrome and neuroleptic malignant syndrome. We describe a patient who has a history of taking two offending drugs that interact with...

Neuroleptic malignant syndrome and serotonin syndrome share many common clinical features, and the term "Neurotoxic syndrome" can be used when a clear distinction cannot be made between the two. Here we present a case of 19-year-old man who experienced serotonin syndrome caused by sertraline intake, and consecutive neuroleptic malignant syndrome by risperidone. This case suggests that these two...

This case report describes a 54-year-old man with bipolar I disorder who was treated with aripiprazole (ARP) and lithium. The patient was admitted to our hospital because of aggravation of depressive symptoms, and treatment with lamotrigine (LTG) was initiated. Two weeks after admission, we discontinued administration of ARP after the appearance of a tremor. Three weeks after discontinuing ARP,...

How "malignant" is the neuroleptic malignant syndrome? In early mild cases it may not be malignant at all Although cases of acute fatal psychoses associated with fever and neuromuscular disturbance have been reported sporadically since the nineteenth century' and the propensity for neuroleptic drugs to disrupt neuromuscular function has been described as their use has grown, the entity of the "...