Su Y-P, Chang C-K, Hayes R D, Harrison S, Lee W, Broadbent M, Taylor D, Stewart R
King's College London, Institute of Psychiatry, London, UK; Department of Psychiatry, Cathay General Hospital, Taipei, Taiwan; School of Medicine, Fu-Jen Catholic University, Taipei, Taiwan.
Acta Psychiatr Scand. 2014 Jul;130(1):52-60. doi: 10.1111/acps.12222. Epub 2013 Nov 15.
To investigate the association between neuroleptic malignant syndrome (NMS) and levels of antipsychotic exposure.
Electronic health record data systematically screened from a large mental health service provider in southeast London provided 67 NMS cases which were individually matched with 254 controls on age, gender, and primary psychiatric diagnosis. Data on psychotropic agents, combinations, dose, and dose change of antipsychotic prescriptions over the preceding 5 (oral agents) or 15 days (depot agents) were extracted and compared between groups using conditional logistic regression models.
NMS was associated with higher number of antipsychotic agents used, use of first-generation agents or aripiprazole, use of first-generation agents only or cross-generation agents, and higher mean and maximum daily doses. In further analyses, associations with antipsychotics type remained significant when adjusted for dose, but those with dose were attenuated following adjustment for type. The specific use of haloperidol, aripiprazole, depot flupentixol, and benzodiazepines was independently associated with NMS. Non-white ethnicity was also found to be associated with NMS.
NMS was primarily associated with type of antipsychotic and polypharmacy rather than overall dose. Variation in risk by ethnicity requires further research.
探讨抗精神病药物恶性综合征（NMS）与抗精神病药物暴露水平之间的关联。
从伦敦东南部一家大型心理健康服务机构系统筛选的电子健康记录数据提供了67例NMS病例，这些病例在年龄、性别和原发性精神疾病诊断方面与254例对照进行了个体匹配。提取了前5天（口服药物）或15天（长效药物）内抗精神病药物处方的精神药物、组合、剂量和剂量变化数据，并使用条件逻辑回归模型在组间进行比较。
NMS与使用的抗精神病药物数量较多、使用第一代药物或阿立哌唑、仅使用第一代药物或跨代药物以及较高的平均和最大日剂量相关。在进一步分析中，调整剂量后与抗精神病药物类型的关联仍然显著，但调整类型后与剂量的关联减弱。氟哌啶醇、阿立哌唑、长效氟奋乃静和苯二氮䓬类药物的特定使用与NMS独立相关。还发现非白人种族与NMS相关。
NMS主要与抗精神病药物类型和联合用药有关，而非总体剂量。种族风险差异需要进一步研究。
