[Antipsychotics and rhabdomyolysis. Differential diagnosis and clinical significance of elevated serum creatine kinase levels in psychiatric practice].
BACKGROUND
Elevated serum CK levels often occur in everyday psychiatric clinical practice. Although the majority of cases are benign and temporary, it is important to recognize and treat these conditions.


METHODS
Review of the literature and case reports.


RESULTS
The authors discuss the etiology, the clinical significance and the management of elevated serum creatine-kinase levels in psychiatric in-patient practice, focusing on antipsychotic-induced rhabdomyolysis. The authors also compare the pathogenesis, the clinical features and the treatment of neuroleptic malignant syndrome and rhabdomyolysis. A brief, practical guideline is introduced, which may help clinicians in the differential diagnosis and in the management of patients with elevated serum creatine kinase activity in emergent psychiatric practice.


CONCLUSIONS
The most common etiologic factors (prescription drugs, alcohol, physical reasons, cardiac etiology) and clinical syndromes (rhabdomyolysis, neuroleptic malignant syndrome, acute coronary syndrome) should be considered, when elevated creatine kinase levels are encountered in psychiatric in-patients. Routine creatine kinase measurements in asymptomatic patients on antipsychotic medications are not recommended, but patients should be carefully followed for the development of rhabdomyolysis, when muscular symptoms arise. Cautiously challenging patients with another antipsychotic after an antipsychotic-induced rhabdomyolysis is recommended to decrease the possibility of recurrence. Careful monitoring of symptoms and potential complications is critical in order to avoid devastating clinical consequences.
Pécsi Tudományegyetem, Pszichiátriai és Pszichoterápiás Klinika, Pécs. viktor.voros@aok.pte.hu
Viktor
V
Vörös
Péter
P
Osváth
Sándor
S
Fekete
Tamás
T
Tényi
D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D003402:Creatine Kinase / Q000097:blood*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000187:drug effects*; D012206:Rhabdomyolysis / Q000139:chemically induced* / Q000175:diagnosis* / Q000201:enzymology / Q000503:physiopathology / Q000517:prevention & control; D012559:Schizophrenia / Q000188:drug therapy; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy
D014150:Antipsychotic Agents; D015415:Biomarkers; D003402:Creatine Kinase