Steingard R, Khan A, Gonzalez A, Herzog D B
J Child Adolesc Psychopharmacol. 1992 Fall;2(3):183-98. doi: 10.1089/cap.1992.2.183.
ABSTRACT A report of neuroleptic malignant syndrome (NMS) in an adolescent patient with bipolar disorder is presented, and findings from a literature review of 35 child and adolescent cases (presenting before age 19) are compared with the reported experience in adults. Fever, rigidity, altered mental status, and tachycardia were observed in more than 70% of cases, and symptoms closely follow the patient's exposure to neuroleptic medications. A majority of the patients were being treated with a high-potency neuroleptic agent and often with more than a single drug. Schizophrenia and bipolar disorder were the most common diagnoses. Neither gender predominates the sample, and adjunctive lithium therapy does not appear to be a significant factor in the genesis of this syndrome in children. Eighty-one percent of the patients recovered, with the majority of patients treated with supportive measures, discontinuation of medications, and adjunctive pharmacotherapy. Only 9 patients were treated with supportive measures alone, and electroconvulsive treatment (ECT) was successfully used in 3 patients. Six patients were reported to have been successfully rechallenged with neuroleptic medications. NMS should be considered in any child with a combination of unexplained fever, rigidity, signs of autonomic dysfunction, changes in mental status, and a history of neuroleptic exposure.
摘要 本文报告了一例患有双相情感障碍的青少年患者发生的抗精神病药恶性综合征（NMS），并将35例儿童及青少年病例（年龄在19岁之前）的文献综述结果与成人病例的报告经验进行了比较。超过70%的病例出现发热、强直、精神状态改变和心动过速，且症状与患者接触抗精神病药物密切相关。大多数患者正在接受高效能抗精神病药物治疗，且常常使用不止一种药物。精神分裂症和双相情感障碍是最常见的诊断。样本中男女比例无明显差异，辅助锂盐治疗似乎不是儿童该综合征发生的重要因素。81%的患者康复，大多数患者接受了支持性措施、停药及辅助药物治疗。仅9例患者仅接受了支持性措施治疗，3例患者成功接受了电休克治疗（ECT）。据报告，6例患者在再次使用抗精神病药物时成功耐受。对于任何出现无法解释的发热、强直、自主神经功能障碍体征、精神状态改变以及有抗精神病药物接触史的儿童，均应考虑NMS。
