Course Hero Logo

Sympathetic nervous system may be respon sible for

Course Hero uses AI to attempt to automatically extract content from documents to surface to you and others so you can study better, e.g., in search results, to enrich docs, and more. This preview shows page 5 - 7 out of 7 pages.

sympathetic nervous system may be respon-sibleformultipleNMSsymptoms(hyper-thermia, muscle rigidity, hypertension,diaphoresis, tachycardia, elevated CK.10NMS can be caused by neuroleptic agents(both first- andsecond-generationanti-psychotics) as well as antiemetics (Table 3,1page 33). The time between use of these med-icationsandonsetofsymptomsishighlyvariable. NMS can occur after a single dose,afteradoseadjustment,orpossiblyafteryears of treatment with the same medication.It is not dose-dependent.11In certain individ-uals, NMS may occur at therapeutic doses.Clinical presentation.Patients with NMStypicallypresentwithatetradofsymp-toms: mental status changes, muscularrigidity, hyperthermia, and autonomicinstability.12Mental status changes canincludeconfusionandagitation,aswellascatatonicsignsandmutism.Themus-cularrigidityofNMSischaracterizedby“leadpiperigidity”andmaybeaccom-paniedbytremor,dystonia,ordyskine-sias. Laboratory findings include elevatedserum CK(from severe rigidity), often>1,000 U/L, although normal levels can beobserved if rigidity has not yet developed.13Treatment.Thefirststepfortreatmentistodiscontinuethecausativemedication.14Initiate supportive therapy immediatelyto restrict the progression ofsymptoms.Interventions include cooling blankets, fluidresuscitation, and antihypertensives to main-tain autonomic stability15or benzodiazepinesto control agitation. In severe cases, muscu-lar rigidity may extendto the airwaysandintubation may be required. The severity ofthese symptoms may warrant admission tothe ICU for close monitoring. Pharmacologictreatment with dantrolene (a muscle relaxantthat blocks calcium efflux from the sarcoplas-mic reticulum) and bromocriptine (a dopa-mineagonist)havebeenutilized.14Incasereports, electroconvulsive therapy (ECT) hasbeenusedtotreatNMS15,16;however,pro-spectiveresearchcomparingECTwithtra-ditionaltreatmenthasnotbeenconducted.It is also worth mentioning that if a clinicianwishes to restart the neuroleptic medication,a 2-week washout period will minimize therisk of NMS recurrence.17Differentiating betweenSS and NMSDifferentiating between these 2 syndromes(Table 4,17page 33) is critical to direct appro-priateintervention.Table517outlinesthetreatment overview for SS and NMS.Table 5Treatment for neuroleptic malignant syndrome vs serotonsyndromeSerotonin syndromeNeuroleptic malignant syndromeStop serotonergic agentStop causative agentsSupportive care(aim to normalize vital signs)Supportive care (possible ICU admission)Sedation with benzodiazepinesMedical therapy (dantrolene, bromocriptine, amantadine)Medical therapy (cyproheptadine)Consider ECT (unclear efficacy)ECT: electroconvulsive therapySource: Reference 17
Current PsychiatryVol. 18, No. 235MDedge.com/psychiatryClinical PointAlthough both SSand NMS can result ileukocytosis, elevateCK, and low serumiron levels, thesefindings are morecommon in NMSDetailedhistory.A detailed history is

Upload your study docs or become a

Course Hero member to access this document

End of preview. Want to read all 7 pages?

Upload your study docs or become a

Course Hero member to access this document

Term
Spring
Professor
Giamanco
Tags
Serotonin Syndrome

Newly uploaded documents

Show More

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture