Edinoff Amber N, Mohammad-Amin Hamza, Odisho Amira S
Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital; Department of Psychiatry and Behavioral Medicine, Louisiana State University Health Science Center Shreveport; Louisiana Addiction Treatment Center.
Department of Psychiatry, Louisiana State University Health Science Center Shreveport.
Health Psychol Res. 2022 Aug 20;10(3):37530. doi: 10.52965/001c.37530. eCollection 2022.
34-year-old African American male with a diagnosis of schizophrenia was placed on aripiprazole and risperidone for psychosis and mood stabilization. Two days after medication initiation, the patient's mentation was altered and he appeared confused with an elevated creatine kinase (CK) at 7101. Medications were held and CK normalized with IV fluids. Quetiapine was initiated after medical stabilization along with lithium and paliperidone palmitate injections. After the second dose of paliperidone palmitate, the patient's mentation was altered, and repeat CK was 4272. The patient received 4 liters of IV fluid and his mental status returned to baseline. There were two case studies noted that had marked increases in serum CK with risperidone use. The first was in an adolescent who was titrated to a dose of risperidone 3mg/ day but the only abnormality was an increase in his CK levels. The next case report was in a 40-year-old female who was on risperidone 2.5mg /day for one year. She had an intention tremor, minor muscle weakness of the lower extremities with a blood pressure of 140/100 and a pulse of 100. She manifested more clinical signs of possible Neuroleptic Malignant Syndrome (NMS). This case highlights the importance of laboratory investigations when there is a high suspicion of possible NMS. It also highlights that some cases of NMS may only present as altered mental status and increased CK in which quick treatment may lead to the prevention of full-blown clinical manifestations of NMS which could be life-threatening.
一名34岁的非裔美国男性，被诊断为精神分裂症，服用阿立哌唑和利培酮以控制精神病症状并稳定情绪。用药两天后，患者的精神状态发生改变，出现意识模糊，肌酸激酶（CK）升高至7101。停用药物后，通过静脉输液CK恢复正常。在病情稳定后开始使用喹硫平，同时联用锂盐和棕榈酸帕利哌酮注射液。在注射第二剂棕榈酸帕利哌酮后，患者的精神状态再次改变，复查CK为4272。患者接受了4升静脉输液，其精神状态恢复至基线水平。有两项病例研究指出，使用利培酮后血清CK显著升高。第一例是一名青少年，利培酮剂量滴定至3mg/天，但唯一的异常是CK水平升高。另一例病例报告是一名40岁女性，服用利培酮2.5mg/天，持续一年。她出现意向性震颤、下肢轻度肌肉无力，血压为140/100，脉搏为100。她表现出更多可能的抗精神病药恶性综合征（NMS）的临床症状。该病例突出了在高度怀疑可能存在NMS时进行实验室检查的重要性。它还强调，一些NMS病例可能仅表现为精神状态改变和CK升高，及时治疗可能有助于预防可能危及生命的NMS全面临床表现的出现。
