Zabel Matthew, Kandukuri Rajeev
College of Osteopathic Medicine, Rocky Vista University College of Osteopathic Medicine, Parker, Colorado, USA
Psychiatry, Parkview Medical Center, Pueblo, Colorado, USA.
BMJ Case Rep. 2024 Feb 6;17(2):e257563. doi: 10.1136/bcr-2023-257563.
An incarcerated male patient with a psychiatric history of schizoaffective disorder presented to the emergency department with muscle rigidity and mutism after receiving a 150 mg haloperidol decanoate injection. At the peak of his illness, symptoms included muscular rigidity, mutism, excessive drooling, an altered level of consciousness, tachycardia, diaphoresis and tremors. Atypical neuroleptic malignant syndrome (NMS) was diagnosed after discrediting similar illnesses through clinical reasoning, laboratory and imaging studies. He was successfully treated during a 40-day hospitalisation with lorazepam, amantadine, methocarbamol and supportive care. This case represents an atypical presentation of NMS due to the patient's lack of fever development. Nonetheless, he satisfied many other criteria, most notably rapid symptom onset after receiving a first-generation antipsychotic medication. The case also provides an opportunity to discuss the prevalence of psychiatric illness among the US incarcerated population and incarceration as a risk factor for developing NMS.
一名患有分裂情感性障碍精神病史的男性囚犯，在接受150毫克癸酸氟哌啶醇注射后，因肌肉僵硬和缄默症被送往急诊科。在病情高峰期，症状包括肌肉僵硬、缄默症、流涎过多、意识水平改变、心动过速、多汗和震颤。通过临床推理、实验室和影像学研究排除了类似疾病后，诊断为非典型抗精神病药恶性综合征（NMS）。他在住院40天期间通过劳拉西泮、金刚烷胺、美索巴莫和支持性护理成功治愈。由于患者未出现发热，该病例代表了NMS的非典型表现。尽管如此，他满足了许多其他标准，最显著的是在接受第一代抗精神病药物治疗后症状迅速出现。该病例还提供了一个机会，来讨论美国被监禁人群中精神疾病的患病率以及监禁作为发生NMS的一个风险因素。
