Daniel Guinart1,2,3, Fuminari Misawa4, Jose M Rubio-Lorente1,2,3, Justin Pereira1, Renato de Filippis1,5, Chiara Gastaldon1,6, John M Kane1,2,3, Christoph U Correll1,2,3,7. 1. Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, New York, NY, USA. 2. Center for Psychiatric Neuroscience, Feinstein Institutes for Medical Research, Manhasset, NY, USA. 3. Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA. 4. Yamanashi Prefectural KITA Hospital, Yamanashi, Japan. 5. Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy. 6. Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy. 7. Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Abstract
OBJECTIVE: Neuroleptic Malignant Syndrome (NMS) is a potentially fatal, idiosyncratic reaction to antipsychotics. Due to low incidence of NMS, research on risk factors of mortality associated with NMS is limited. METHODS: Two authors independently searched Medline/Embase/Cochrane/CINAHL/PsychINFO databases for case reports with author-defined NMS published in English until 05/30/2020. Demographic, clinical, treatment and outcome data were independently extracted following PRISMA guidelines. NMS severity was rated using the Francis-Yacoub scale. Mortality risk factors were identified using a multivariable regression analysis including all characteristics that were significantly different between NMS cases resulting vs not resulting in death. RESULTS: 683 cases with NMS were analyzed (median age=36 years, males=62.1%). In a multivariable model, independent predictors of NMS mortality were lack of antipsychotic discontinuation (odds ratio (OR)=4.39 95% confidence interval(CI)=2.14-8.99; p<0.0001), respiratory problems (OR=3.54 95%CI=1.71-7.32; p=0.0004), severity of hyperthermia (Unit-OR=1.30, 95%CI=1.16-1.46; p<0.0001), and older age (Unit-OR=1.05, 95%CI=1.02-1.07; p=0.0014). Even in univariate, patient level analyses antipsychotic formulation was not related to death (oral antipsychotic (OAP): n=39/554 (7.0%) vs long-acting injectable (LAI): n=13/129 (10.1%); p=0.2413). Similarly, death with NMS was not related to antipsychotic class (first-generation antipsychotic: n=38/433 (8.8%) vs second-generation antipsychotic: n=8/180 (4.4%); p=0.0638). Non-antipsychotic co-treatments were not associated with NMS mortality. CONCLUSION: Despite reliance on case reports, these findings indicate that presence of respiratory alterations, severity of hyperthermia and older age should alert clinicians to a higher NMS mortality risk, and that antipsychotics should be stopped to reduce mortality, yet when NMS arises on LAIs, mortality is not increased vs OAPs. This article is protected by copyright. All rights reserved.
OBJECTIVE:Neuroleptic Malignant Syndrome (NMS) is a potentially fatal, idiosyncratic reaction to antipsychotics. Due to low incidence of NMS, research on risk factors of mortality associated with NMS is limited. METHODS: Two authors independently searched Medline/Embase/Cochrane/CINAHL/PsychINFO databases for case reports with author-defined NMS published in English until 05/30/2020. Demographic, clinical, treatment and outcome data were independently extracted following PRISMA guidelines. NMS severity was rated using the Francis-Yacoub scale. Mortality risk factors were identified using a multivariable regression analysis including all characteristics that were significantly different between NMS cases resulting vs not resulting in death. RESULTS: 683 cases with NMS were analyzed (median age=36 years, males=62.1%). In a multivariable model, independent predictors of NMSmortality were lack of antipsychotic discontinuation (odds ratio (OR)=4.39 95% confidence interval(CI)=2.14-8.99; p<0.0001), respiratory problems (OR=3.54 95%CI=1.71-7.32; p=0.0004), severity of hyperthermia (Unit-OR=1.30, 95%CI=1.16-1.46; p<0.0001), and older age (Unit-OR=1.05, 95%CI=1.02-1.07; p=0.0014). Even in univariate, patient level analyses antipsychotic formulation was not related to death (oral antipsychotic (OAP): n=39/554 (7.0%) vs long-acting injectable (LAI): n=13/129 (10.1%); p=0.2413). Similarly, death with NMS was not related to antipsychotic class (first-generation antipsychotic: n=38/433 (8.8%) vs second-generation antipsychotic: n=8/180 (4.4%); p=0.0638). Non-antipsychotic co-treatments were not associated with NMSmortality. CONCLUSION: Despite reliance on case reports, these findings indicate that presence of respiratory alterations, severity of hyperthermia and older age should alert clinicians to a higher NMSmortality risk, and that antipsychotics should be stopped to reduce mortality, yet when NMS arises on LAIs, mortality is not increased vs OAPs. This article is protected by copyright. All rights reserved.
Authors: Alexandria S Coles; Dunja Knezevic; Tony P George; Christoph U Correll; John M Kane; David Castle Journal: Front Psychiatry Date: 2021-12-15 Impact factor: 4.157
Authors: Stanley N Caroff; Christopher B Roberts; Henry Rosenberg; Joseph R Tobin; Stacey Watt; Darlene Mashman; Sheila Riazi; Rosalind M Berkowitz Journal: BMC Anesthesiol Date: 2022-09-19 Impact factor: 2.376