title: Zotepine-induced catatonia as a precursor in the progression to neuroleptic malignant syndrome.
abstract: 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.
authors.affiliation: Department of Psychiatry, Kaohsiung Medical University Hsiaokang Hospital, Kaohsiung, Taiwan.
authors.forename: Jui-Hsiu
authors.initials: JH
authors.lastname: Tsai
authors.forename: Pinchen
authors.initials: P
authors.lastname: Yang
authors.forename: Ju-Yu
authors.initials: JY
authors.lastname: Yen
authors.forename: Cheng-Chung
authors.initials: CC
authors.lastname: Chen
authors.forename: Ming-Jen
authors.initials: MJ
authors.lastname: Yang
mesh_terms: 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
chemical_list: D014150:Antipsychotic Agents; D003988:Dibenzothiepins; D018967:Risperidone; C022172:zotepine