Unal Gonca Ayse
Clinic of Psychiatry, Mersin Sehir Egitim ve Arastirma Hastanesi, Toroslar, Mersin, Turkey.
Medicine (Baltimore). 2025 Mar 7;104(10):e41171. doi: 10.1097/MD.0000000000041171.
Neuroleptic malignant syndrome (NMS) is a rare, life-threatening complication of neuroleptic (antipsychotic) medications. Paliperidone is an atypical antipsychotic used in the treatment of schizophrenia. While current evidence suggests that atypical oral antipsychotics have a lower incidence of NMS compared to typical oral antipsychotics, there is limited information available on the incidence and management of NMS associated with long-acting injectable (LAI) antipsychotics. More case studies are needed to fully understand the true incidence of NMS associated with LAI atypical antipsychotics. This report aims to present our experience with a patient with schizophrenia who developed NMS as a result of taking LAI paliperidone, an atypical antipsychotic.
A 63-year-old male diagnosed with schizophrenia was brought to the emergency room with complaints of high fever, muscle contraction, tremors, urinary and fecal incontinence, and a change of consciousness, which started 2 days after the first LAI paliperidone injection. During the psychiatric examination, the patient exhibited tremors, a high fever of 39.5°C, and muscle rigidity. He was confused and had impaired orientation. The patient's creatine kinase, white blood cell count, aspartate aminotransferase, and alanine aminotransferase levels were measured at 1895 U/L, 13750/mm3, 55 IU/L, and 45 IU/L, respectively. The electrocardiogram showed sinus tachycardia.
The patient's psychiatric examination, vital signs, and laboratory results were consistent with NMS.
The patient received treatment with bromocriptine and amisulpride for 13 days.
With this treatment, the patient's delirium improved and the patient became stable. The levels of creatine kinase, white blood cell count, aspartate aminotransferase, and alanine aminotransferase decreased to normal values. The patient was discharged from the hospital after 14 days of treatment.
Although NMS is not very common in patients using antipsychotics, it is important because it is an emergency condition that can result in death if not treated appropriately. Clinicians should consider NMS in patients taking atypical antipsychotics such as paliperidone.
抗精神病药物恶性综合征（NMS）是一种罕见的、危及生命的抗精神病药物并发症。帕利哌酮是一种用于治疗精神分裂症的非典型抗精神病药物。虽然目前的证据表明，与典型口服抗精神病药物相比，非典型口服抗精神病药物发生NMS的发生率较低，但关于长效注射用（LAI）抗精神病药物相关NMS的发生率和管理的信息有限。需要更多的病例研究来充分了解与LAI非典型抗精神病药物相关的NMS的真实发生率。本报告旨在介绍我们对一名因使用LAI帕利哌酮（一种非典型抗精神病药物）而发生NMS的精神分裂症患者的治疗经验。
一名63岁男性，诊断为精神分裂症，因首次注射LAI帕利哌酮2天后出现高热、肌肉收缩、震颤、大小便失禁及意识改变，被送往急诊室。在精神检查期间，患者表现出震颤、39.5°C的高热和肌肉强直。他神志不清，定向力障碍。患者的肌酸激酶、白细胞计数、天冬氨酸转氨酶和丙氨酸转氨酶水平分别测定为1895 U/L、13750/mm3、55 IU/L和45 IU/L。心电图显示窦性心动过速。
患者的精神检查、生命体征和实验室检查结果与NMS一致。
患者接受了溴隐亭和氨磺必利治疗13天。
经过该治疗，患者的谵妄症状改善，病情稳定。肌酸激酶、白细胞计数、天冬氨酸转氨酶和丙氨酸转氨酶水平降至正常。治疗14天后患者出院。
虽然NMS在使用抗精神病药物的患者中并不常见，但它很重要，因为它是一种紧急情况，如果治疗不当可能导致死亡。临床医生在使用帕利哌酮等非典型抗精神病药物的患者中应考虑NMS。
