Sarmiento Bernard, Gunther Matthew, Cohen-Oram Alexis, Jiang Shixie
Department of Psychiatry, Massachusetts General Hospital/McLean Hospital, Boston, MA; Harvard Medical School, Boston, MA.
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA.
J Acad Consult Liaison Psychiatry. 2025 Mar-Apr;66(2):139-151. doi: 10.1016/j.jaclp.2024.12.003. Epub 2025 Jan 3.
Neuroleptic malignant syndrome (NMS) is a rare yet potentially fatal iatrogenic syndrome that can manifest with life-threatening symptoms. Theorized to be caused by the dopamine-blocking effects of certain medications, such as antipsychotics, or the withdrawal of dopaminergic agents, NMS is characterized by hyperthermia, autonomic instability, altered mental status, and muscular rigidity. Most treated cases resolve within weeks; however, in some cases, residual catatonic symptoms can persist for months after the resolution of acute hyperthermic and hypermetabolic symptoms. The utilization of dopaminergic agents, such as bromocriptine, to alleviate the catatonic symptoms of NMS has been described in the literature but has not been explored systematically.
The objective of this study is to present a case where high-dose bromocriptine was used to successfully treat significant, residual catatonia following NMS and to further delineate the role of bromocriptine in the management of residual catatonia secondary to NMS through a systematic review.
This study presents an illustrative case report and a systematic review of bromocriptine use in managing residual NMS catatonia. The databases of PubMed, Cochrane, PsycINFO, EBSCO, and OVID Medline were queried, identifying 338 studies. Utilizing Covidence, 137 duplicate articles and 76 irrelevant studies were excluded. Ultimately, 125 studies were assessed for eligibility, yielding 7 manuscripts and 9 total cases of bromocriptine use in residual NMS catatonia. Including our case, bromocriptine use led to an improvement in catatonic symptoms in 80.0% of patients (8 out of 10) and resolved catatonic symptoms in 50.0% of patients (5 out of 10).
Based on this case and the accompanying systematic review, bromocriptine may serve as an effective treatment for residual catatonia following NMS, particularly when first-line strategies such as benzodiazepine and/or electroconvulsive therapy treatment have failed or are infeasible. This highlighted efficacy of bromocriptine may be attributed to relieving persistent dopaminergic blockade in susceptible patients, necessitating further research into the etiological heterogeneity of catatonia.
抗精神病药恶性综合征（NMS）是一种罕见但可能致命的医源性综合征，可表现出危及生命的症状。理论上，它由某些药物（如抗精神病药）的多巴胺阻断作用或多巴胺能药物的撤药引起，其特征为高热、自主神经功能不稳定、精神状态改变和肌肉强直。大多数接受治疗的病例在数周内痊愈；然而，在某些情况下，残留的紧张症症状在急性高热和高代谢症状消退后可能持续数月。文献中已描述使用多巴胺能药物（如溴隐亭）来缓解NMS的紧张症症状，但尚未进行系统研究。
本研究的目的是报告一例使用大剂量溴隐亭成功治疗NMS后严重残留紧张症的病例，并通过系统评价进一步阐明溴隐亭在治疗NMS继发的残留紧张症中的作用。
本研究呈现了一份说明性病例报告以及对溴隐亭用于治疗残留NMS紧张症的系统评价。检索了PubMed、Cochrane、PsycINFO、EBSCO和OVID Medline数据库，共识别出338项研究。利用Covidence软件，排除了137篇重复文章和76项不相关研究。最终，评估了125项研究的 eligibility，得到7篇手稿和9例使用溴隐亭治疗残留NMS紧张症的病例。包括我们的病例在内，使用溴隐亭使80.0%的患者（10例中的8例）紧张症症状得到改善，50.0%的患者（10例中的5例）紧张症症状得到缓解。
基于该病例及相关系统评价，溴隐亭可能是治疗NMS后残留紧张症的有效方法，尤其是在苯二氮䓬类药物和/或电休克治疗等一线策略失败或不可行时。溴隐亭这种突出的疗效可能归因于缓解了易感患者持续的多巴胺能阻滞，这需要对紧张症的病因异质性进行进一步研究。
