Department of Psychiatry, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 9 Curie-Skłodowskiej Street, 85-094, Bydgoszcz, Poland.
BMC Psychiatry. 2020 Apr 19;20(1):179. doi: 10.1186/s12888-020-02597-x.
Neuroleptic malignant syndrome (NMS) may be induced by atypical antipsychotic drugs (AAPDs) such as aripiprazole, olanzapine, risperidone and quetiapine, either as a single treatment or in combination with other drugs. A case of NMS following the administration of lamotrigine, aripiprazole and quetiapine in a patient with bipolar disorder, and with renal failure caused by toxic lithium levels has not been reported.
A 51-year-old female patient with a 27-year history of bipolar disorder, being treated with lithium, fluoxetine, olanzapine, gabapentine, perazine and biperiden, was admitted to the hospital due to depressed mood and delusions. A urinary tract infection was diagnosed and antibiotic therapy was initiated. After 5 days of treatment her physical state deteriorated and she developed a fever of 38.4 °C. Her laboratory results revealed a toxic level of lithium (2.34 mmol/l). Acute renal failure was diagnosed and the lithium was withdrawn. After stabilization of her condition, and despite her antipsychotic treatment, further intensification of delusions and depressed mood were observed. All drugs being taken by the patient were withdrawn and lamotrigine and aripiprazole were initiated. Due to the insufficient effectiveness of aripiprazole treatment and because of problems with sleep, quetiapine was added, however further treatment with this drug combination and an increase of quetiapine to 400 mg/d eventually caused NMS. Amantadine, lorazepam and bromocriptine were therefore initiated and the patient's condition improved.
This case report indicates that concurrent use of multiple antipsychotic drugs in combination with mood stabilizers in patients with organic disorders confers an increased risk of NMS development.
神经阻滞剂恶性综合征（NMS）可能由非典型抗精神病药物（AAPD）引起，如阿立哌唑、奥氮平、利培酮和喹硫平，无论是单一治疗还是与其他药物联合使用。在一名双相情感障碍患者中，锂中毒水平导致肾功能衰竭，同时使用拉莫三嗪、阿立哌唑和喹硫平后发生 NMS 的病例尚未报道。
一名 51 岁女性，双相情感障碍病史 27 年，曾接受锂、氟西汀、奥氮平、加巴喷丁、哌嗪和比哌立登治疗，因情绪低落和妄想入院。诊断为尿路感染并开始抗生素治疗。治疗 5 天后，她的身体状况恶化并出现 38.4°C 的发热。实验室结果显示锂中毒（2.34mmol/L）。诊断为急性肾衰竭并停用锂。病情稳定后，尽管她接受了抗精神病治疗，但仍出现妄想和情绪低落进一步加重。停用了患者正在服用的所有药物，并开始使用拉莫三嗪和阿立哌唑。由于阿立哌唑治疗效果不足，且存在睡眠问题，因此添加了喹硫平，但随后使用该药物组合和增加喹硫平剂量至 400mg/d 最终导致 NMS。因此开始使用金刚烷胺、劳拉西泮和溴隐亭，患者病情改善。
本病例报告表明，在有机障碍患者中，同时使用多种抗精神病药物联合心境稳定剂会增加 NMS 发生的风险。
