Chatterton R, Cardy S, Schramm T M
Wolston Park Hospital, Wacol, Queensland, Australia.
Aust N Z J Psychiatry. 1996 Oct;30(5):692-3. doi: 10.3109/00048679609062668.
This report identifies neuroleptic malignant syndrome (NMS) occurring on a steady state dosage of clozapine monotherapy.
An outpatient presented with a recent history of stiffness and soreness of his legs, dizziness, polydipsia, polyuria, abdominal and chest pains. After admission to a general hospital, further symptomatology was identified including: pallor, diaphoresis, nausea, confusion, agitation, decrease in normal reflexes, minimally reactive pupils and rigid limbs.
Intravenous (I/V) diazepam was administered but failed to decrease the agitation and confusion. He was sedated with the administered of I/V droperadol, intubated and placed on a ventilator with circulatory supports for 4 days.
On day five he was extubated and transfered to a medical ward. All laboratory values had returned to normal values by this time. The patient was subsequently discharged.
Neuroleptic malignant syndrome can occur at any stage of clozapine treatment, and the patient can be rechallenged after such an episode. This person was rechallenged and after 6 months of treatment has suffered no further recurrence of NMS.
本报告确定了在氯氮平单一疗法的稳定剂量下发生的神经阻滞剂恶性综合征（NMS）。
一名门诊患者近期出现腿部僵硬和酸痛、头晕、烦渴、多尿、腹痛和胸痛。入住综合医院后，发现了进一步的症状，包括：面色苍白、出汗、恶心、意识模糊、躁动、正常反射减弱、瞳孔反应微弱和肢体僵硬。
静脉注射地西泮，但未能减轻躁动和意识模糊。给他静脉注射氟哌利多使其镇静，插管并使用呼吸机并给予循环支持4天。
第5天他拔管并转入内科病房。此时所有实验室值均恢复正常。患者随后出院。
神经阻滞剂恶性综合征可发生在氯氮平治疗的任何阶段，且患者在发作后可再次接受治疗。该患者再次接受治疗，经过6个月的治疗，未再发生NMS。
