Enasio Morris1, Digby Green, Andis Graudins. 1. Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Kensington, Australia.
Abstract
UNLABELLED: Neuroleptic malignant syndrome (NMS) is a relatively uncommon side effect that may develop after a recent increase in the therapeutic dose of an antipsychotic medication or the addition of a new agent in therapeutic doses. CASE REPORT: We report a case of NMS developing in a 36-year-old female patient 2 days following deliberate self-poisoning with 30 x 10-mg olanzapine tablets, 7 x 100-mg chlorpromazine tablets and an unknown amount of escitalopram. These were the patient's own medications. She had not been taking these for several weeks. The patient initially presented with sedation from her overdose which resolved over the next 24 hours. Following this, over the subsequent 24 hours, she became progressively confused, ataxic, hypertonic, ferbrile and tachycardic, with marked lead pipe rigidity of the limbs. Head CT, lumbar puncture and septic screen were all negative. She was treated with intravenous midazolam infusion, nasogastrically administered bromocriptine, external cooling and was mechanically ventilated. She gradually improved over a period of 10 days, with residual confusion lasting another week, and was discharged well with no deterioration from her premorbid neurologic state. CONCLUSION: To our knowledge, although there are numerous cases reported with therapeutic use, NMS has not been reported to develop following acute olanzapine overdose. Clinicians should be aware that this may be an uncommon side effect of antipsychotic medication.
UNLABELLED: Neuroleptic malignant syndrome (NMS) is a relatively uncommon side effect that may develop after a recent increase in the therapeutic dose of an antipsychotic medication or the addition of a new agent in therapeutic doses. CASE REPORT: We report a case of NMS developing in a 36-year-old female patient 2 days following deliberate self-poisoning with 30 x 10-mg olanzapine tablets, 7 x 100-mg chlorpromazine tablets and an unknown amount of escitalopram. These were the patient's own medications. She had not been taking these for several weeks. The patient initially presented with sedation from her overdose which resolved over the next 24 hours. Following this, over the subsequent 24 hours, she became progressively confused, ataxic, hypertonic, ferbrile and tachycardic, with marked lead pipe rigidity of the limbs. Head CT, lumbar puncture and septic screen were all negative. She was treated with intravenous midazolam infusion, nasogastrically administered bromocriptine, external cooling and was mechanically ventilated. She gradually improved over a period of 10 days, with residual confusion lasting another week, and was discharged well with no deterioration from her premorbid neurologic state. CONCLUSION: To our knowledge, although there are numerous cases reported with therapeutic use, NMS has not been reported to develop following acute olanzapineoverdose. Clinicians should be aware that this may be an uncommon side effect of antipsychotic medication.
Authors: D Sierra-Biddle; A Herran; S Diez-Aja; J M Gonzalez-Mata; E Vidal; F Diez-Manrique; J L Vazquez-Barquero Journal: J Clin Psychopharmacol Date: 2000-12 Impact factor: 3.153
Authors: Vassilis P Kontaxakis; Beata J Havaki-Kontaxaki; Nikolaos G Christodoulou; Konstantinos G Paplos; George N Christodoulou Journal: Ann Gen Hosp Psychiatry Date: 2003-10-29