Zotepine-induced catatonia as a precursor in the progression to neuroleptic malignant syndrome.
A 39-year-old man with schizophrenia developed severe catatonia, hyperthermia, muscle rigidity, tachycardia, leukocytosis, and elevated muscle enzyme levels while receiving zotepine therapy. Neuroleptic malignant syndrome (NMS) was diagnosed. After withdrawal of zotepine therapy, transfer to a neurologic intensive care unit, provision of supportive care, and administration of adjunctive bromocriptine therapy, the patient's fever and catatonia subsided. Biochemical irregularities spontaneously returned to normal with no complications. Antipsychotic therapy was restarted with risperidone 12 days after the patient's NMS resolved. After more than 1 year of follow-up, he experienced no adverse events. A recent decrease in mortality from NMS is related to increased awareness of this disorder, but not to treatment with specific agents. Clinicians need to recognize NMS early; although rare, it is a potentially fatal complication of antipsychotic treatment.
Tsai
Jui-Hsiu
JH
Department of Psychiatry, Kaohsiung Medical University Hsiaokang Hospital, Kaohsiung, Taiwan.
Yang
Pinchen
P
Yen
Ju-Yu
JY
Chen
Cheng-Chung
CC
Yang
Ming-Jen
MJ
D014150:Antipsychotic Agents / Q000009:adverse effects*; D001774:Blood Chemical Analysis; D002389:Catatonia / Q000139:chemically induced* / Q000523:psychology; D003988:Dibenzothiepins / Q000009:adverse effects*; D018450:Disease Progression; D005334:Fever / Q000139:chemically induced; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009459:Neuroleptic Malignant Syndrome / Q000503:physiopathology* / Q000523:psychology; D018967:Risperidone / Q000627:therapeutic use; D012563:Schizophrenia, Paranoid / Q000150:complications / Q000188:drug therapy
D014150:Antipsychotic Agents; D003988:Dibenzothiepins; D018967:Risperidone; C022172:zotepine