Article Title: Neuroleptic Malignant Syndrome: A Sixteen Years Retrospective Review
Author(s): Abul Faizi, Haider A. Naqvi
Institute(s): Department of Psychiatry, The Aga Khan University, P.O. Box 3500, Stadium Road, Karachi 74800.
Journal: Journal of Pakistan Psychiatric Society, 2007; 4(1): 33–36 ORIGINAL ARTICLE
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Objective: To study demographic characteristics, psychiatric diagnosis, type of neuroleptic drugs administered, course of illness, management and outcome.
Design: Retrospective chart review study.
Place and duration of study: This study was carried out for sixteen years (1988-2004) in the Psychiatry unit, Aga Khan University Hospital, Karachi.
Subjects and Methods: Sample consisted of 25 cases of Neuroleptic Malignant Syndrome in which 13 were males and 12 were females. The record was taken from the health information management system which keeps a comprehensive chart of each patient. This renders the files retrievable through computer generated search. A specific data collection form was designed for extraction of relevant data. The data was analyzed using SPSS version 13.0.
Results: Twenty five cases were identified, of which thirteen were males. Mean age was 45 years (range 20-74 years). Bipolar affective disorder was the most common diagnosis followed by schizo-affective disorder, schizophrenia, postpartum psychosis, dementia and Parkinsonism. 48% of the patients had previous history of neuroleptic use, while 28% received neuroleptics for the first time. Among neuroleptic users, 20% were on long-acting depot antipsychotics. 52% received per-oral dose (PO), while 32% received intramuscular (IM) dose. 56% patients were on other concomitant medications among which Lithium was the most common (16%). 96% patients had the cardinal symptoms of fever, rigidity and increased creatine phosphokinase (CPK). 96% had associated delirium, 80% showed autonomic instability with fluctuation in pulse and blood pressure. Electrolyte disturbance was seen in 84% and diaphoresis with leukocytosis was present in 68% patients. NMS was associated with high ambient temperature with mean temperature of 39.20 C (S.E. 0.3). Discontinuation of neurolpetic medications and supportive care was carried out in all cases. In our case series we observed mortality rate of 16%. Out of 25 patients, 21 recovered with early diagnosis and adequate management.
Conclusion: Risk of NMS can be minimized by use of low potency or atypical antipsychotics, cautious use of concomitant medications and depot preparations and initiation of neurolpetics at lower dose with careful monitoring. With good supportive medical care mortality can be substantially mimimized.
Key words: Neuroleptic malignant syndrome (NMS), neuroleptics, creatine phosphokinase (CPK).