Neuroleptic malignant syndrome: further lessons from a case report.
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.
Casamassima
Francesco
F
Dept. of Psychiatry, Mass. General Hospital, Boston, MA 02114, USA. fcasamassima@hotmail.it
Lattanzi
Lorenzo
L
Perlis
Roy H
RH
Litta
Antonella
A
Fui
Erika
E
Bonuccelli
Ubaldo
U
Fricchione
Gregory
G
Cassano
Giovanni B
GB
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
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