TY  -  JOUR
AU  -  Brogna, Pasquale
AU  -  Colasuonno, Rosangela
AU  -  di Michele, Flavia
AU  -  Paterniti, Angela Maria
AU  -  Talamo, Alessandra
AU  -  Ribolsi, Michele
AU  -  Jannini, Tommaso B.
AU  -  Siracusano, Alberto
AU  -  Niolu, Cinzia
T1  -  Diagnostic and therapeutic challenges in neuroleptic malignant syndrome: a severe medical case
PY  -  2020
Y1  -  2020-07-01
DO  -  10.1708/3417.34000
JO  -  Rivista di Psichiatria
JA  -  Riv Psichiatr
VL  -  55
IS  -  4
SP  -  236
EP  -  239
PB  -  Il Pensiero Scientifico Editore
SN  -  2038-2502
Y2  -  2026/04/29
UR  -  http://dx.doi.org/10.1708/3417.34000
N2  -  SUMMARY. Neuroleptic malignant syndrome (NMS) is a rare, idiosyncratic medical emergency usually associated with the use of dopamine antagonists, commonly typical antipsychotic drugs. However, it has been observed that it can occur with atypical antipsychotics as well. NMS is characterized by altered consciousness, fever, rigidity, autonomic instability and high creatine phosphokinase (CPK) blood levels. Here, we report a case of a 44-year-old female patient with history of a treatment-resistant bipolar disorder. She was admitted to our psychiatric ward for severe psychomotor agitation and treated with a therapy based on typical and atypical antipsychotics. During the course of the hospitalization she developed NMS. In this case, the diagnosis was delayed due to the slow and insidious symptom presentation, therefore requiring a differential diagnosis. Autoimmune NMDA receptor encephalitis, catatonic syndrome and malignant catatonia have been excluded. The patient met all the DSM-5 criteria for NMS: exposure to dopamine-blocking agent, severe muscle rigidity, fever, diaphoresis, dysphagia, altered level of consciousness, mutism, tremors, tachycardia, high or labile blood pressure, leukocytosis, high creatine phosphokinase. Since robust evidence-based protocols are lacking, here we discuss the relevance of this case in order to highlight the hurdles of a prompt diagnosis, clinical management of associated complications and treatment possibilities for such emergency.
ER  -