Verma Karan, Jayadeva Vivek, Serrano Raymond, Sivashanker Karthik
Department of Psychiatry, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA.
VA Boston Healthcare System, Boston, MA, USA.
Case Rep Psychiatry. 2018 Jun 11;2018:4016087. doi: 10.1155/2018/4016087. eCollection 2018.
Neuroleptic malignant syndrome (NMS), an iatrogenic form of malignant catatonia, carries high morbidity and mortality rates especially in the context of delayed recognition and standard intervention protocol of lorazepam trial. However, there is limited guidance available through literature for further management if benzodiazepine treatment is ineffective and electroconvulsive therapy (ECT) is not readily accessible. This case report describes a multimodal approach to address the diagnostic, treatment, and logistical system challenges in an acute medical hospital through the case of a 69-year-old man with schizophrenia who represented from a psychiatric ward with neuroleptic malignant syndrome. We educated our inpatient colleagues for timely recognition of hyperexcited subtype of catatonia to avoid iatrogenic progression to neuroleptic malignant syndrome and our medical colleagues on the clinical course of catatonic symptoms to avoid any further disagreements and delays in treatment. We advocated for timely electroconvulsive therapy in the setting of limited access and utilized creative pharmacologic strategies such as N-methyl-D-aspartate (NMDA) receptor antagonists and longer acting benzodiazepines while managing medical complications.
抗精神病药恶性综合征（NMS）是恶性紧张症的一种医源性形式，尤其是在识别延迟和采用劳拉西泮试验的标准干预方案的情况下，其发病率和死亡率很高。然而，如果苯二氮䓬类药物治疗无效且无法立即获得电休克治疗（ECT），则通过文献可获得的进一步管理指导有限。本病例报告通过一名69岁患有精神分裂症的男性患者从精神科病房转来患有抗精神病药恶性综合征的病例，描述了一种多模式方法，以应对急性综合医院在诊断、治疗和后勤系统方面所面临的挑战。我们对住院同事进行培训，使其能及时识别紧张症的过度兴奋亚型，以避免医源性进展为抗精神病药恶性综合征，并对医疗同事进行关于紧张症症状临床过程的培训，以避免在治疗上出现任何进一步的分歧和延误。在可获得的ECT有限的情况下，我们主张及时进行ECT，并在管理医疗并发症的同时，采用如N-甲基-D-天冬氨酸（NMDA）受体拮抗剂和长效苯二氮䓬类药物等创新药物策略。
