Tsai Meng-Chang, Huang Tiao-Lai
Department of Psychiatry, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Chang Gung Med J. 2010 Sep-Oct;33(5):576-80.
Neuroleptic malignant syndrome (NMS) is an idiosyncratic and potentially fatal adverse complication of antipsychotic medications and other dopamine-modulating agents. It is characterized by hyperthermia, muscle rigidity, autonomic dysfunction and alteration in mental status. Here, we report a patient with severe NMS who was successfully treated with highdose lorazepam and diazepam. A 61-year-old man with bipolar I disorder was admitted to the hospital because of manic episodes. Fever, muscle rigidity, tachycardia, diaphoresis, elevated blood pressure and delirium occurred following intramuscular injection of haloperidol and NMS was diagnosed. Supportive treatment included hydration, alkalinized fluids and correction of abnormal electrolytes without the use of dantrolene, dopaminergic agents or electroconvulsive therapy. The Francis-Yacoub NMS rating scale was employed for evaluation of clinical improvement, and scores were 55 on the first day and 0 at discharge. The patient was followed up for 6 months and was free of NMS. In conclusion, this is the first report of rapid relief of NMS with high-dose lorazepam and diazepam in a Taiwanese patient.
抗精神病药物恶性综合征（NMS）是抗精神病药物和其他多巴胺调节药物特有的、潜在致命的不良并发症。其特征为高热、肌肉强直、自主神经功能障碍及精神状态改变。在此，我们报告1例严重NMS患者，经大剂量劳拉西泮和地西泮成功治疗。1名患有双相I型障碍的61岁男性因躁狂发作入院。肌肉注射氟哌啶醇后出现发热、肌肉强直、心动过速、多汗、血压升高及谵妄，诊断为NMS。支持性治疗包括补液、碱化液体及纠正电解质异常，未使用丹曲林、多巴胺能药物或电休克治疗。采用弗朗西斯-亚库布NMS评定量表评估临床改善情况，第1天评分为55分，出院时为0分。对该患者随访6个月，未再发生NMS。总之，这是台湾地区首例关于大剂量劳拉西泮和地西泮快速缓解NMS的报告。
