Hosseini Seyedhamze, Elyasi Forouzan
Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Department of Psychiatry, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
Iran J Med Sci. 2017 May;42(3):306-309.
Neuroleptic malignant syndrome (NMS) is a rare but life-threatening idiosyncratic side effect resulting from neuroleptic drugs. NMS mainly occurs in patients treated with high-potency typical antipsychotics, but rarely caused by atypical antipsychotics. Although NMS is less common with atypical antipsychotic, but it seems that its incidence is rising due to increased administration of such drugs. We present the case of a 27-year-old man with a history of paranoid schizophrenia that showed signs consistent with NMS that occurred after treatment with olanzapine. The patient was adherent to treatment. He had decreased level of consciousness, muscle rigidity, diaphoresis, fever, drooling, urinary incontinence, and high blood pressure. This patient illustrates that NMS can occur due to treatment with atypical antipsychotic drugs like olanzapine, particularly in the presence of risk factors. This phenomenon is often unrecognized, underdiagnosed, or not treated properly. Physicians should be aware that NMS with extrapyramidal syndrome could occur with olanzapine at steady state doses without recent dosage adjustments or titration. It is essential that adequate and safe dose of medication is chosen and the patient is monitored by the signs and symptoms of this lethal syndrome.
抗精神病药恶性综合征（NMS）是一种由抗精神病药物引起的罕见但危及生命的特异质性副作用。NMS主要发生在使用高效典型抗精神病药物治疗的患者中，但很少由非典型抗精神病药物引起。虽然NMS在使用非典型抗精神病药物时较少见，但由于此类药物使用增加，其发病率似乎正在上升。我们报告一例27岁有偏执型精神分裂症病史的男性患者，其在用奥氮平治疗后出现了与NMS一致的体征。该患者坚持治疗。他出现意识水平下降、肌肉强直、出汗、发热、流涎、尿失禁和高血压。该患者表明，使用奥氮平这类非典型抗精神病药物治疗可导致NMS，尤其是在存在危险因素的情况下。这种现象常常未被识别、诊断不足或治疗不当。医生应意识到，在未近期调整剂量或滴定的稳定剂量下，奥氮平可能会引发伴有锥体外系综合征的NMS。选择足够且安全的药物剂量并通过这种致命综合征的体征和症状对患者进行监测至关重要。
