title: Neuroleptic malignant syndrome: further lessons from a case report.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Dept. of Psychiatry, Mass. General Hospital, Boston, MA 02114, USA. fcasamassima@hotmail.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Casamassima
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Lattanzi
authors.forename: Roy H
authors.initials: RH
authors.lastname: Perlis
authors.forename: Antonella
authors.initials: A
authors.lastname: Litta
authors.forename: Erika
authors.initials: E
authors.lastname: Fui
authors.forename: Ubaldo
authors.initials: U
authors.lastname: Bonuccelli
authors.forename: Gregory
authors.initials: G
authors.lastname: Fricchione
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Cassano
mesh_terms: D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000925:Anticoagulants / Q000008:administration & dosage; D014150:Antipsychotic Agents / Q000009:adverse effects; D001714:Bipolar Disorder / Q000150:complications; D001971:Bromocriptine / Q000008:administration & dosage; D002389:Catatonia / Q000139:chemically induced / Q000188:drug therapy; D003975:Diazepam / Q000008:administration & dosage; D018491:Dopamine Agonists / Q000008:administration & dosage; D004565:Electroconvulsive Therapy / Q000379:methods*; D004573:Electrolytes / Q000008:administration & dosage; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D005500:Follow-Up Studies; D018757:GABA Modulators / Q000627:therapeutic use*; D006220:Haloperidol / Q000009:adverse effects; D006801:Humans; D008140:Lorazepam / Q000627:therapeutic use*; D009459:Neuroleptic Malignant Syndrome / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D018712:Analgesics, Non-Narcotic; D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D014150:Antipsychotic Agents; D018491:Dopamine Agonists; D004573:Electrolytes; D018757:GABA Modulators; D001971:Bromocriptine; D006220:Haloperidol; D008140:Lorazepam; D003975:Diazepam