A neuroleptic malignant syndrome (Short form MNS) is also known as Neuroleptic Malignant Syndrome. This is a rare side effect that results from taking neuroleptics.
What is Neuroleptic Malignant Syndrome?
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The neuroleptic syndrome is a rare but life-threatening clinical picture which is triggered by dopamine antagonists (especially neuroleptics), but also by lithium or antidepressants. It usually occurs with a high dose of medication or a rapid increase in the dose in the first four weeks after starting therapy or changing the medication.
The neuroleptic syndrome is said to appear in around 0.2 percent of patients who are treated with neuroleptics. The clinical picture could be observed most frequently with the intake of haloperidol, but in principle also with all other neuroleptics. In addition, individual familial cases are known, so that a genetic component with regard to the development of the disease cannot be ruled out.
A neuroleptic malignant syndrome is a dreaded emergency in psychiatry because the clinical picture progresses quickly and can also quickly trigger life-threatening complications.
causes
The drugs that can trigger a neuroleptic malignant syndrome include:
- Aripiprazole
- Carbamazepine
- Low-potency neuroleptics such as chlorpromazine, perazine, pipamperon and triflupromazine
- Thioxanthenes: Chlorprothixen and Flupentixol
- Tricyclic antidepressants: desipramine and trimipramine
- Phenothiazine prokinetics: domperidone and metoclopramide
- Common phenothiazines: fluphenazine and perphenazine
- Butyrophenones: haloperidol, benperidol and melperone
- lithium
- Pimozide
- Atypical neuroleptics: risperidone and aripiprazole
- SSRIs: sertraline and escitalopram
- SNRI: Tiapride
- Benzamides: amisulpride
Other risk factors such as the use of strong antipsychotic neuroleptics and a high dosage can promote a malignant neuroleptic syndrome. Existing brain damage and thyroid diseases can also influence the development of a neuroleptic malignant syndrome. This also applies to physical exhaustion, lack of fluids or hyponatremia.
Symptoms, ailments & signs
A malignant neuroleptic syndrome causes various symptoms such as extrapyramidal motor disorders, extreme muscle stiffness or eye cramps. Those affected sweat profusely, sometimes sweating, tachycardia and tachypnea occur. Palpitations, rapid breathing and changes in blood pressure, urinary or fecal incontinence have also been observed in such a case.
Furthermore, speech and swallowing disorders, increased salivation and an increase in body temperature can occur. Confusion, impaired consciousness, and even coma are all associated with Neuroleptic Malignant Syndrome.
In most cases, neuroleptic malignant syndrome begins less than ten days after starting therapy with the drug that is triggering it. In rare cases this can take up to two months. The malignant neuroleptic syndrome usually develops into a full picture within two days, but sometimes even after a few hours.
Diagnosis & course of disease
In order to make the diagnosis that a neuroleptic malignant syndrome is present, general measures are first carried out, for example measuring fever and blood pressure. The latter can be either high or low, but is also often unstable. Further signs are usually an increase in CPK, but it can also be only slight, an increased LDH (lactate dehydrogenase), leukocytosis, proteinuria and myoglobinuria.
In addition, there is hyponatremia and hypernatremia, a slight increase in protein in the CSF, low serum iron, serum calcium and magnesium. A diagnosis and treatment as early as possible are very important in order to avoid consequential damage. A serious complication that can cause neuroleptic malignant syndrome is rhabdomyolysis with myoglobinuria.
This can lead to acute kidney failure.Other risks are hyperthermia, which may cause dehydration, which in turn can trigger phlebothrombosis and pulmonary embolism. Seizures are also possible.
In the worst case, a malignant neuroleptic syndrome can lead to multiple organ failure. The clouding and especially the stiff muscles and the fever can increase rapidly and very quickly lead to life-threatening decompensation. Therefore, treatment is indispensable.
Complications
With neuroleptic syndrome there are usually many different complaints. However, they do not always point directly to the syndrome, so that in many cases treatment is delayed. As a rule, those affected suffer from greatly increased perspiration and also from strong sweats. These can significantly limit and reduce the quality of life.
Likewise, with neuroleptic syndrome it is not uncommon for a palpitations to occur, which in the worst case can lead to a heart attack. Those affected suffer from fecal incontinence, which often leads to depression and other psychological disorders. Those affected continue to suffer from a fever and, if the disease is not treated, often from kidney failure. This can lead to death and the affected person is then dependent on dialysis or a donor kidney.
The treatment of the neuroleptic syndrome is relatively easy and quick with the help of medication and an increased supply of fluids. There are no complications and the symptoms can be resolved relatively easily. As a rule, with early treatment, the life expectancy of the patient is not reduced by the neuroleptic syndrome.
When should you go to the doctor?
People who are under the influence of a drug from the range of neuroleptics should consult a doctor in the event of negative changes in their health. If there are motor disorders or cardiac rhythm disorders, a medical clarification of the complaints is required.
A doctor should be consulted in the event of a racing heart, increased blood pressure, sweating, increased oxygen requirements or other vegetative irregularities. If breathing is difficult or if the person concerned suffers from rapid breathing, a doctor should be consulted. If there are communication problems, there is also cause for concern. Consult a doctor if you have language or swallowing problems.
A dry mouth and throat, an interruption in the regular natural flow of saliva and a high body temperature are signs of an existing irregularity. A doctor's visit is necessary so that the treatment plan for the treatment of the underlying disease can be optimized. If there is an irregularity in the digestive tract, incontinence or problems using the toilet, a doctor should be consulted.
If the patient shows mental confusion or a disturbance of consciousness sets in, a doctor must be informed of the observations, as these are important warnings for the organism. If you lose consciousness, call an ambulance service. The person concerned needs first aid from those present until the emergency doctor arrives.
Treatment & Therapy
The primary measure if neuroleptic malignant syndrome is diagnosed is to stop the causative neuroleptic or the triggering antipsychotic immediately. All other measures serve more as support and relate primarily to securing the important vital functions. This may include ventilation, rehydration and the avoidance of further complications.
The loss of fluids and electrolytes must be balanced out and the fever can be reduced with medication as quickly as possible. Sometimes, in difficult cases, intermittent dialysis may be necessary. Muscle relaxants and dopamine agonists are also effective supports. Other measures include monitoring such as an EKG, volume replacement and thrombosis prophylaxis.
In severe cases or if there is no improvement after 24 hours, Dantrolen is used. This is the case with increased muscle tension, which leads to severe muscle spasms. Due to the fact that a neuroleptic malignant syndrome is a life-threatening clinical picture, it is treated in the intensive care unit.
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➔ Medicines to calm down and strengthen nervesOutlook & forecast
Without the fastest possible medical care, the prognosis for this syndrome is poor. There is a life-threatening condition that requires action as soon as possible. Otherwise the person concerned will die prematurely. The disease is triggered by a side effect of medical preparations prescribed by a doctor for the treatment of an existing primary disease. For this reason, the additional symptoms can be alleviated if cooperation with the attending physician is sought.
As soon as the first health problems appear, the doctor who is treating the underlying disease should be consulted. A change in the treatment plan is necessary so that the malignant neuroleptic syndrome regresses and can be completely treated. The administration of alternative medication alleviates the health irregularities that have occurred. The unwanted side effects will gradually disappear if you respond as quickly as possible. Otherwise, in addition to the development of a life-threatening condition, irreparable damage to the organism can also occur.
The risk of impaired kidney function is significantly increased by the triggering drugs. In the event of an unfavorable course of the disease, permanent complications can therefore arise despite all efforts. In addition, seizures can occur, which can also trigger irreversible changes. An improved prognosis is achieved by immediately increasing the intake of fluids in addition to consulting the doctor.
prevention
Since a malignant neuroleptic syndrome usually occurs as a side effect of medication, it is not possible to prevent the disease, but only to avert it by stopping the medication causing it immediately. For this it is important to pay close attention to possible side effects and changes in relation to the body when taking and to take them very seriously.
Since the likelihood of a neuroleptic malignant syndrome recurring is significantly increased, it is also very important to start a new neuroleptic therapy very carefully and sensitively. Ideally, atypical neuroleptics are prescribed, which are taken in the lowest possible dose to keep the risk low from the start. It is also important, if a change of doctor is pending, to inform a new doctor about the previous illness, if the use of appropriate medication is planned.
Aftercare
There is usually no cure for a drug allergy. To avoid discomfort, the patient must stop taking the drug in question and no longer take it in the future. This is the only way to prevent the disease from recurring. This requires a high degree of personal responsibility in everyday life.
Follow-up care in the case of neuroleptic syndrome basically aims to address complications preventively. This is particularly important in life-threatening situations. Since treatment takes a few minutes, such knowledge can be vital. Since drug intolerance is always present, the most effective aftercare is to protect against dangerous consequences. This can only be done by avoiding any substances.
You can do that yourself
If irregularities or abnormalities occur when taking neuroleptics, the person concerned should seek a discussion with the treating doctor in his own interest. Since neuroleptic malignant syndrome is treated in an intensive care unit, the possibilities for self-help are very limited. Delays in consulting a doctor lead to a rapid deterioration in health and should be avoided.
The disease is associated with numerous symptoms and complaints, which are often overwhelming for the sick person and their relatives. Fears and worries of everyone involved should not become too strong. It is imperative that you refrain from getting into it. The exchange with relatives, therapists or also sick people can be helpful. Language barriers can be overcome with digital aids or sign language. Basically, a positive attitude towards life and its challenges is important. They help to cope with the events and lead to new possible solutions. Thinking should be positive and realistic at the same time. It is helpful to set new goals that are achievable and do not cause further stress.
In order not to suffer additional illnesses, a healthy lifestyle is important. A healthy diet, optimized sleeping conditions and the supply of sufficient oxygen strengthen the immune system and promote well-being. At the same time, the consumption of harmful substances such as alcohol or nicotine is to be avoided.
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