Berardi D, Amore M, Keck P E, Troia M, Dell'Atti M
Institute of Psychiatry, University of Bologna, Italy.
Biol Psychiatry. 1998 Oct 15;44(8):748-54. doi: 10.1016/s0006-3223(97)00530-1.
Pharmacologic and clinical risk factors for neuroleptic malignant syndrome have been suggested. High neuroleptic dose, rapid dosage increase, and parenteral administration were identified as risk factors in a case-control study; however, there are limited data regarding potential clinical risk factors.
To examine potential clinical risk factors, we conducted a case-control study, comparing 12 cases to 24 controls, all treated with neuroleptics at our center. In addition to examining previously postulated pharmacologic risk factors, we also assessed for presence of psychomotor agitation, confusion, disorganization, and catatonia.
Significant differences were found between cases and controls for psychomotor agitation, confusion, disorganization, catatonia, mean and maximum neuroleptic dose, parenteral neuroleptic injections, neuroleptic dose increase within 5 days of the episode, magnitude of neuroleptic dose increase from initial dose, and extrapyramidal signs.
This study demonstrated that psychopathological features such as psychomotor agitation, confusion, disorganized behavior, and catatonia may be risk factors for the neuroleptic malignant syndrome, in addition to pharmacologic risk factors and extrapyramidal signs, including akathisia. In clinical practice, careful monitoring for prodromal signs of neuroleptic malignant syndrome is required during neuroleptic treatment of patients with psychomotor agitation, confusion, and/or disorganization, while in the presence of catatonia these drugs should be avoided.
已有研究提出了抗精神病药物恶性综合征的药理学和临床风险因素。在一项病例对照研究中，高剂量抗精神病药物、快速增加剂量以及胃肠外给药被确定为风险因素；然而，关于潜在临床风险因素的数据有限。
为了研究潜在的临床风险因素，我们开展了一项病例对照研究，将12例病例与24例对照进行比较，所有病例均在我们中心接受抗精神病药物治疗。除了研究先前假定的药理学风险因素外，我们还评估了精神运动性激越、意识模糊、行为紊乱和紧张症的存在情况。
病例组与对照组在精神运动性激越、意识模糊、行为紊乱、紧张症、抗精神病药物平均剂量和最大剂量、胃肠外抗精神病药物注射、发作5天内抗精神病药物剂量增加、抗精神病药物剂量相对于初始剂量的增加幅度以及锥体外系症状方面存在显著差异。
本研究表明，除了药理学风险因素和锥体外系症状（包括静坐不能）外，精神运动性激越、意识模糊、行为紊乱和紧张症等精神病理学特征可能是抗精神病药物恶性综合征的风险因素。在临床实践中，在对有精神运动性激越、意识模糊和/或行为紊乱的患者进行抗精神病药物治疗期间，需要仔细监测抗精神病药物恶性综合征的前驱症状，而对于存在紧张症的患者，应避免使用这些药物。
