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$Unique_ID{BRK04043}
$Pretitle{}
$Title{Neuroleptic Malignant Syndrome}
$Subject{Neuroleptic Malignant Syndrome Heat Stroke Tardive Dyskinesia
Malignant Hyperthermia Anaphylaxis}
$Volume{}
$Log{}
Copyright (C) 1990 National Organization for Rare Disorders, Inc.
763:
Neuroleptic Malignant Syndrome
** IMPORTANT **
It is possible that the main title of the article (Neuroleptic Malignant
Syndrome) is not the name you expected. Please check the SYNONYM listing to
find the alternate names and disorder subdivisions covered by this article.
Synonyms
Information on the following diseases can be found in the Related
Disorders section of this report:
Heat Stroke
Tardive Dyskinesia
Malignant Hyperthermia
Anaphylaxis
General Discussion
** REMINDER **
The information contained in the Rare Disease Database is provided for
educational purposes only. It should not be used for diagnostic or treatment
purposes. If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.
Neuroleptic Malignant Syndrome is a potentially fatal reaction to any of
a group of antipsychotic drugs or major tranquilizers (neuroleptics). These
drugs are commonly prescribed for the treatment of schizophrenia and other
neurological, mental or emotional disorders. Phenothiazines are one type of
neuroleptic and may occasionally be prescribed as a treatment for nausea and
vomiting. Several of the most commonly prescribed neuroleptics include
thioridazine, haloperidol, chlorpromazine, fluphenazine and perphenazine.
Major tranquilizers or neuroleptics have a strong effect on thought
disturbances associated with paranoid thinking, delusions, anxiety and
agitation. Neuroleptic Malignant Syndrome occurs when a person taking these
drugs reacts with a high fever and other heart, respiratory and muscle
symptoms which is a side effect of these drugs.
Symptoms
Symptoms of Neuroleptic Malignant Syndrome may include very high fever (102
to 104 degrees F), irregular pulse, accelerated heartbeat (tachycardia),
increased rate of respiration (tachypnea), muscle rigidity, altered mental
status, autonomic nervous system dysfunction, high or low blood pressure,
seizures, tremors and profuse perspiration. Respiratory failure may occur as
the result of infection, shock or aspiration. Other symptoms may include
liver or kidney failure, abnormally high potassium levels (hyperkalemia),
major destruction of skeletal muscle tissue (rhabdomyolysis) or blood clots
in veins and arteries.
Causes
The exact cause of Neuroleptic Malignant Syndrome is not known. Scientists
believe that the disorder may be due to a major disturbance of the mechanism
that controls normal body temperature. This disturbance may occur when
phenothiazines block transmission of the brain chemical (neurotransmitter)
dopamine, or when the drug interferes with other neurotransmitters in the
brain. This disorder may also be related to Malignant Hyperthermia, a
genetic disorder characterized by an abnormal reaction to anesthesia drugs.
(See related disorders section for more information about Malignant
Hyperthermia.)
Affected Population
Neuroleptic Malignant Syndrome may affect any individual who is taking
phenothiazines. Men appear to be at higher risk than women. Scientists
believe that the drugs most commonly involved are the stronger neuroleptic
medications including major tranquilizers such as haloperidol, fluphenazine,
trifluoperazine and perphenazine.
Related Disorders
Symptoms of the following disorders can be similar to those of Neuroleptic
Malignant Syndrome. Comparisons may be useful for a differential diagnosis:
Heat Stroke is a very serious condition characterized by an abrupt and
rapid increase in body temperature which may reach as high as 104 to 106
degrees F. Heat stroke usually results from exposure to an extremely hot
environment. The skin may become hot, flushed and dry. Rapid loss of fluids
may result in the inability to sweat. Sweating is necessary to cool the
body. Sweating is necessary to cool the body. There may also be an increase
in pulse rate and respiration. The affected individual may become
disoriented and eventually experience convulsions or slip into
unconsciousness. Measures such as wrapping the individual in cold, wet
sheets should be taken immediately to lower body temperature. An individual
suffering from heat stroke should be hospitalized as quickly as possible.
(For more information on this disorder, choose "Hyperthermia" as your search
term in the Rare Disease Database.)
Malignant Hyperthermia is a genetic disorder characterized by an abnormal
response to muscle relaxants and general anesthesia drugs. Symptoms of
Malignant Hyperthermia are apparent only after the patient has been placed
under general anesthesia. Along with rapidly elevating body temperature
which may rise as high as 110 degrees, muscle rigidity and/or muscle
twitching occurs. The patient may also exhibit a very rapid and irregular
heartbeat, abnormally low blood pressure, sickly sweet breath, headache,
nausea and vomiting. It is not known whether Neuroleptic Malignant
Hyperthermia is a variant form of Malignant Hyperthermia, but some
researchers have suggested that these disorders may be related. (For more
information on this disorder, choose "Malignant Hyperthermia" as your search
term in the Rare Disease Database.)
Anaphylaxis is an abnormally severe allergic reaction to a substance.
Major symptoms may include severe itching, hives, flushing, swelling,
vomiting, diarrhea, difficulty breathing and unconsciousness. High fever is
not a symptom of this disorder. (For more information on this disorder,
choose "Anaphylaxis" as your search term in the Rare Disease Database.)
The following disorder may be associated with the extended use of
neuroleptic drugs. It is not necessary for a differential diagnosis:
Tardive Dyskinesia is a disorder which results from the long-term use of
neuroleptic drugs and is characterized by involuntary and abnormal movements
of the jaw, lips and tongue. Typical symptoms include grimacing, sticking
out the tongue, and sucking or fishlike movements of the mouth. A high
percentage of schizophrenic people who have spent long periods of time in
mental hospitals taking neuroleptic drugs, have a high risk of developing
Tardive Dyskinesia. (For more information on this disorder, choose "Tardive
Dyskinesia" for your search term in the Rare Disease Database.)
Therapies: Standard
Treatment of Neuroleptic Malignant Syndrome consists of withdrawal of
neuroleptic medications under a doctor's supervision, prompt and intensive
care with adequate hydration and nutrition, and immediate measures to lower
body temperature. Medications prescribed as treatment may include
dantrolene, bromocriptine, amantadine, cogentin or diazepam. Secondary
complications such as decreased alkalinity of the blood and tissues
(acidosis), a deficiency of oxygen reaching the tissues (hypoxia), and kidney
(renal) insufficiency must be treated independently. Once patients have
recovered from Neuroleptic Malignant Syndrome, they are sometimes slowly and
cautiously reintroduced to other neuroleptic medications. The patient must
be carefully monitored as reoccurrences of Neuroleptic Malignant Syndrome
have been reported.
Therapies: Investigational
This disease entry is based upon medical information available through July
1990. Since NORD's resources are limited, it is not possible to keep every
entry in the Rare Disease Database completely current and accurate. Please
check with the agencies listed in the Resources section for the most current
information about this disorder.
Resources
For more information on Neuroleptic Malignant Syndrome, please contact:
National Organization for Rare Disorders (NORD)
P.O. Box 8923
New Fairfield, CT 06812-1783
(203) 746-6518
National Mental Health Association
1021 Prince St.
Alexandria, VA 22314
National Alliance for the Mentally Ill
1901 N. Ft. Meyer Dr., Suite 500
Arlington, VA 22209
(703) 514-7600
National Mental Health Consumer Self-Help Clearinghouse
311 S. Juniper St., Rm. 902
Philadelphia, PA 19107
(215) 735-2481
NIH/National Institute of Mental Health (NIMH)
9000 Rockville Pike
Bethesda, MD 20205
(301) 443-4515 or (301) 496-1752
(800) 421-4211 (24 hrs.)
Malignant Hyperthermia Association of the U.S.
Box 3231
Darien, CT. 06820
References
THE MERCK MANUAL, Volume 1, 14th Ed.: Robert Berkow, M.D., ed.-in-chief;
Merck Sharp & Dohme Laboratories, 1982. Pp. 2489-2490.
RECURRENCE OF NEUROLEPTIC MALIGNANT SYNDROME. V.L. Susman et al.; J NERV
MENT DIS (April, 1988: issue 176 (4)). Pp. 234-241.
PATIENTS WITH NEUROLEPTIC MALIGNANT SYNDROME HISTORIES: WHAT HAPPENS
WHEN THEY ARE HOSPITALIZED? A.J. Gelenberg et al.; J CLIN PSYCHIATRY (May,
1989: issue 50 (5)). Pp. 18-25.
CLINICAL DIFFERENTIATION BETWEEN LETHAL CATATONIA AND NEUROLEPTIC
MALIGNANT SYNDROME. E. Castillo et al.; AM J PAYCHIATRY (March, 1989: issue
146 (3)). Pp. 324-328.