Neuroleptic malignant syndrome: further lessons from a case report

Francesco Casamassima, Lorenzo Lattanzi, Roy H Perlis, Antonella Litta, Erika Fui, Ubaldo Bonuccelli, Gregory Fricchione, Giovanni B Cassano
Psychosomatics 2010, 51 (4): 349-54

BACKGROUND: Neuroleptic malignant syndrome (NMS) represents an iatrogenic form of malignant catatonia, and simple catatonia has been shown to predispose to NMS.

OBJECTIVE: The authors present the case of a bipolar patient with catatonic features who developed NMS after receiving haloperidol.

METHOD: Supportive therapy, including rehydration, electrolyte restoration, and blood pressure aids were given, together with antipyretics, antibiotics, and anticoagulants. The patient was also started on bromocriptine and diazepam.

RESULTS: Supportive care, diazepam, and dopamine agonists yielded only partial benefit. However, switching from diazepam to lorazepam, in combination with electroconvulsive therapy (ECT) and a long-acting dopamine agonist led to the resolution of NMS.

CONCLUSION: This case sheds further light on the relationship between catatonia and NMS. As noted in the literature, ECT in combination with lorazepam proved to be safe and effective for NMS.

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