olanzapine and Neuroleptic-Malignant-Syndrome

Phenibut is a glutamic acid derivative with activity on the γ-aminobutyric acid (GABA)B, A, and B-phenethylamine receptors. It is prescribed in former Communist Bloc countries for anxiolysis and related psychiatric disorders. It can be easily obtained in Western countries and is thought to have abuse potential. Abrupt discontinuation has been reported to precipitate an abstinence syndrome. A review of the literature identified 22 reported cases, many of which were notable for severe psychomotor agitation and requirements for aggressive pharmacologic treatment. Neurologic and autonomic signs and symptoms may mimic serotonin or neuroleptic malignant syndrome. Patients were typically younger and had coexisting substance abuse disorders to other drugs. Also presented is a case of a 23-year-old male with an acute phenibut abstinence syndrome. This patient exhibited severe psychomotor agitation requiring physical restraints, dexmedetomidine, lorazepam, haloperidol, diphenhydramine, cyproheptadine, melatonin, olanzapine, and baclofen for symptom control.

Topics: Akathisia, Drug-Induced; Baclofen; Cyproheptadine; Dexmedetomidine; Diphenhydramine; GABA-A Receptor Antagonists; GABA-B Receptor Agonists; gamma-Aminobutyric Acid; Haloperidol; Humans; Lorazepam; Male; Melatonin; Neuroleptic Malignant Syndrome; Olanzapine; Receptors, GABA; Substance Withdrawal Syndrome; Substance-Related Disorders; Young Adult

Topics: Antipsychotic Agents; Female; Humans; Middle Aged; Neuroleptic Malignant Syndrome; Olanzapine

Behavioral and psychological symptoms of dementia pose management challenges for caregivers and clinicians. Firstline nonpharmacologic treatments include eliminating physical and emotional stressors, modifying the patient's environment, and establishing daily routines. Family members and caregivers benefit from education about dementia symptoms and reminders that the behaviors are normal and unintentional. Cognitive and emotion-oriented interventions, sensory stimulation interventions, behavior management techniques, and other psychosocial interventions are modestly effective. In refractory cases, physicians may choose to prescribe off-label antipsychotics. Aripiprazole has the most consistent evidence of symptom improvement; however, this improvement is small. Olanzapine, quetiapine, and risperidone have inconsistent evidence of benefit. Physicians should use the smallest effective dose for the shortest possible duration to minimize adverse effects, most notably an increased mortality risk. Other adverse effects include anticholinergic and antidopaminergic effects, extrapyramidal symptoms, neuroleptic malignant syndrome, postural hypotension, metabolic syndrome, cardiac arrhythmia, and sedation. Patients should be monitored for these effects while receiving treatment; however, laboratory monitoring may be limited to patients receiving long-term therapy.

Topics: Antipsychotic Agents; Aripiprazole; Arrhythmias, Cardiac; Basal Ganglia Diseases; Behavior Therapy; Benzodiazepines; Cognitive Behavioral Therapy; Dementia; Emotions; Humans; Hypotension, Orthostatic; Metabolic Syndrome; Neuroleptic Malignant Syndrome; Olanzapine; Practice Guidelines as Topic; Psychotic Disorders; Quetiapine Fumarate; Risperidone

Serotonin syndrome and neuroleptic malignant syndrome are two drug toxidromes that have often overlapping and confusing clinical pictures. We report a case of a young man who presented with alteration of mental status, autonomic instability and neuromuscular hyperexcitability following ingestion of multiple psychiatric and antiepileptic medications. The patient satisfied criteria for serotonin syndrome and neuroleptic malignant syndrome, and based on the characteristic clinical features, laboratory findings and clinical course it was concluded that the patient had both toxidromes. The patient was managed with cyproheptadine and supportive measures, and recovered over the course of 3 weeks. A brief review of literature highlighting the diagnostic clues as well as the importance of recognising and distinguishing the often missed and confounding diagnoses follows.

Topics: Antimanic Agents; Antipsychotic Agents; Benzodiazepines; Clonazepam; Diagnosis, Differential; GABA Modulators; Humans; Lithium Compounds; Male; Neuroleptic Malignant Syndrome; Olanzapine; Risperidone; Serotonin Syndrome; Valproic Acid; Young Adult

Neuroleptic malignant syndrome (NMS) is the most dangerous life-threatening complication of antipsychotic medication. It's development is connected with the blockade of dopaminergic transmission (D2 receptors) in the nigrostriatal system of the brain. Fever is one of the main symptoms of this syndrome and it's elevation is due to the activation of the immune system. Numerous studies report that treatment with clozapine (doses 37.5-600 mg) or olanzapine (doses 10-25 mg) or the use of these drugs in polytherapy cause pyrexia between 37.8-40.6 °C. Additionally, levels of proinflammatory interleukins such as IL-6, IL-1,TNF-α were increased. The aim of this article is to describe how olanzapine and clozapine influence fever development in NMS, in relation to the dose of the drug taken by schizophrenic patients including changes in immunological system.

Topics: Antipsychotic Agents; Benzodiazepines; Clozapine; Dose-Response Relationship, Drug; Fever; Humans; Inflammation Mediators; Interleukins; Neuroleptic Malignant Syndrome; Olanzapine; Schizophrenia

To retrospectively examine published cases of neuroleptic malignant syndrome (NMS) in patients aged 18 and below who had been treated with atypical antipsychotics (clozapine, risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole).. Information was collected via MEDLINE searches in February 2006 and May 2007. The term neuroleptic malignant syndrome was used and cross-referenced with individual atypical antipsychotics. The authors also contacted (by telephone and in writing) pharmaceutical companies that produce and market atypical antipsychotics for any data on NMS.. Twenty case reports (written in English only and published from 1991-2007) were identified and reviewed. These publications all described symptoms of NMS in patients aged 18 or younger who had been treated with atypical antipsychotics.. Data were reviewed and compared with 3 diagnostic criteria (DSM-IV-TR, Levenson's, and Caroff and Mann's) for NMS. Interventions and outcomes were also reviewed.. Twenty case reports were identified and presented with a descriptive approach. Sixteen cases met criteria for NMS, with at least 1 of the diagnostic sets utilized. The majority of cases involved male subjects. All patients recovered.. Young patients can develop NMS during treatment with atypical antipsychotics. Symptoms of this disorder are consistent with those described in adults. Although NMS is rare in this population, clinicians should maintain a high index of suspicion. Appropriate caution in treating children and adolescents with any antipsychotic is warranted.

Topics: Adolescent; Antipsychotic Agents; Aripiprazole; Benzodiazepines; Bipolar Disorder; Child; Child, Preschool; Clozapine; Dibenzothiazepines; Humans; Neuroleptic Malignant Syndrome; Olanzapine; Piperazines; Quetiapine Fumarate; Quinolones; Retrospective Studies; Risperidone; Thiazoles

A 16-year-old boy developed fever, generalized rigidity, leukocytosis, and increased serum transaminase and creatine kinase levels while receiving treatment with olanzapine and lithium. When both drugs were discontinued, his fever and rigidity subsided and biochemical irregularities spontaneously returned to normal, without any complications. Classic neuroleptic malignant syndrome (NMS) was diagnosed. Concomitant administration of lithium with olanzapine may place patients at risk for NMS. Clinicians need to be aware of this rare but potentially fatal side effect in patients of all ages, and especially in adolescents receiving both drugs.

Topics: Adolescent; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Diagnosis, Differential; Drug Therapy, Combination; Humans; Lithium; Male; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine

Neuroleptic malignant syndrome is the rarest and the most serious of the neuroleptic induced movement disorders. Although potent neuroleptics are more frequently associated with NMS, atypical antipsychotic drugs may also be a cause of NMS. Three databases were searched using the terms 'olanzapine' and 'neuroleptic' 'malignant syndrome'. Case reports were selected and reviewed from among all articles that fulfilled the search criteria. Twenty six cases were reviewed. Twenty cases fulfilled the criteria published by Sachdev et al. Olanzapine was the most probable cause of NMS in 16 cases. The absence of rigidity was described in only two of 16 highly probable olanzapine induced NMS cases, which is not as often as it is reported in clozapine associated NMS (36%). It was found that prior NMS is an important risk factor in NMS.

Topics: Antipsychotic Agents; Benzodiazepines; Humans; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine; Schizophrenia

The frequency of neuroleptic malignant syndrome (NMS) after clozapine or olanzapine is low and often of non-serious nature. A 49 year-old female patient developed NMS 12 days after olanzapine re-exposure. Olanzapine was stopped, the patient was transferred to an ICU and received a course of nine uni- and bilateral ECT treatments. This led to remission. 14 months earlier the patient had presented with a first severe NMS episode after haloperidol depot injection and 4 days after starting oral clozapine. Following the first NMS episode olanzapine (20 mg per day) was administered for 11 months without adverse effects.

Topics: Antipsychotic Agents; Benzodiazepines; Critical Care; Electroconvulsive Therapy; Female; Haloperidol; Humans; Middle Aged; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine; Psychotic Disorders; Recurrence

Neuroleptic malignant syndrome (NMS) is an uncommon but serious idiosyncratic reaction associated with antipsychotic medication. The purpose of this study was to reveal and analyze the clinical characteristics of the reported cases of NMS in patients given the novel antipsychotic olanzapine. A MEDLINE search related to olanzapine-induced NMS cases reported in the international literature was conducted. All cases were critically reviewed and examined against three different sets of NMS diagnostic criteria (DSM-IV, Addonizio, Levenson). The authors identified 17 cases of possible NMS associated with olanzapine. Ten of the reported NMS cases were definitely NMS meeting all three sets of criteria and three cases were probable NMS meeting two sets of criteria. Most of the patients exhibited a full-blown NMS. There were four definite NMS cases associated with olanzapine monotherapy. Three of them had concurrent serious physical illnesses and one had a previous NMS episode. Olanzapine can cause NMS, mainly in susceptible or predisposed patients.

Topics: Benzodiazepines; Humans; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine; Retrospective Studies; Schizophrenia

Data from clinical trials reviewed in this article fulfill predictions based on preclinical findings that atypical antipsychotic drugs are associated with a reduced potential for inducing extrapyramidal symptoms (EPS) and other movement disorders. Atypical drugs have been shown to reduce all subtypes of acute EPS, the frequency of EPS-related patient dropouts, and the need for concomitant antiparkinsonian drug use. Clozapine remains superior to other atypicals in treating psychosis without worsening motor symptoms in patients with Parkinson's disease. Atypicals may be selectively advantageous in treating schizophrenic patients with a predisposition to catatonia. Although the risk of developing lethal neuroleptic malignant syndrome may be diminished with atypical drugs, clinicians must remain alert to the signs of this disorder. Atypicals have reduced liability for inducing tardive dyskinesia (TD) and show antidyskinetic properties in patients with preexisting TD. Passive resolution of TD may be facilitated in some patients by the use of these agents. Thus, the risk of movement disorders has become only one of several considerations in choosing among antipsychotic drugs.

Topics: Akathisia, Drug-Induced; Antipsychotic Agents; Benzodiazepines; Clozapine; Dyskinesia, Drug-Induced; Humans; Neuroleptic Malignant Syndrome; Neurotoxicity Syndromes; Olanzapine; Pirenzepine; Risperidone

Topics: Antipsychotic Agents; Benzodiazepines; Humans; Male; Middle Aged; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine; Schizophrenia, Paranoid; Selective Serotonin Reuptake Inhibitors

Although neuroleptic drugs have become the mainstay of treating acute and chronic psychosis, they are substantially limited by troublesome side effects. The traditional neuroleptic drugs have a wide array of central nervous system and peripheral system side effects that often lead to problems in management or patient noncompliance. Of particular difficulty are the extrapyramidal symptoms and tardive dyskinesia. However, other side effects of seizures, sedation, neuroleptic malignant syndrome and cardiovascular, hematologic, endocrinological, and weight gain problems remain as clinical management challenges posed by existing antipsychotic drug therapy. Considerable progress has been made in improving the motor side effect profile with the advent of clozapine and risperidone. However, each of these drugs has its own dose-limiting side effect profile. Two new drugs, olanzapine and sertindole, are now added to the pharmacopeia for treating psychosis. They further improve the benefit/ risk ratio because they have even fewer EPS and other side effects. Overall, these new antipsychotic agents greatly improve the treatment of psychosis by reducing drug-induced morbidity and improving the quality of life for patients.

Topics: Antipsychotic Agents; Basal Ganglia Diseases; Benzodiazepines; Clozapine; Dyskinesia, Drug-Induced; Humans; Imidazoles; Indoles; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine; Psychotic Disorders; Risperidone; Schizophrenia; Seizures; Sleep; Weight Gain

Olanzapine is a commonly used and effective second-generation antipsychotic agent used for the control of paranoia and agitation in schizophrenia and bipolar disorder as well as in the behavioural and psychological symptoms of dementia. Serious side effects of treatment are uncommon but spontaneous rhabdomyolysis represents a rare complication. We describe here a patient treated with a stable dose of olanzapine for more than 8 years who developed acute severe rhabdomyolysis without an identifiable trigger and without features suggestive of neuroleptic malignant syndrome. The rhabdomyolysis was atypical in its delayed onset and severity with a creatine kinase level of 345 125 U/L, the highest level reported in the available literature. We also describe the clinical manifestations of delayed-onset olanzapine-induced rhabdomyolysis and its differentiation from neuroleptic malignancy syndrome, and we highlight key aspects of management to prevent or minimise further complications such as acute kidney injury.

Topics: Antipsychotic Agents; Benzodiazepines; Humans; Neuroleptic Malignant Syndrome; Olanzapine; Rhabdomyolysis; Schizophrenia

We present this case to draw attention to the importance of early diagnosis in terms of life-saving, noting that greater awareness is important among healthcare professionals. Our patient developed neuroleptic malignant syndrome (NMS) after his neuroleptic drug dosage was increased. His condition was complicated by acute kidney injury (AKI) which required hemodialysis. The uniqueness of this case is that the causative agent of NMS is an atypical antipsychotic, and atypical antipsychotics are generally considered to be safer than typical antipsychotics.. A 31-year-old Chinese man with underlying schizophrenia presented to our hospital with aggressive behavior. He was admitted to the psychiatric hospital and started on his regular medications, with an increase in the dose of olanzapine tablet from 5 to 10 mg daily. After 5 days in the ward, the patient was noted to have high fever, restlessness, confusion, increased muscle rigidity, tachycardia and tachypnoea. Antipsychotic therapy was stopped in view of suspected NMS. The first laboratory test for serum creatine kinase (CK) showed a markedly high level of this molecule. His renal profile showed raised serum creatinine in comparison to 2 months prior when the baseline serum creatinine was within the normal range. A diagnosis of NMS with AKI was made. Although the patient was given adequate intravenous fluid hydration with close monitoring of urine output, his renal function did not show improvement but continued to show a worsening trend. In view of this, he was started on urgent hemodialysis. The patient was dependent on intermittent hemodialysis before his AKI showed complete recovery. After 2 weeks, his blood test results returned to normal. He was discharged well.. Neuroleptic malignant syndrome is a life-threatening iatrogenic medical emergency in which high index of clinical suspicion is required for diagnosis and prompt treatment.

Topics: Acute Kidney Injury; Adult; Antipsychotic Agents; Creatine Kinase; Creatinine; Humans; Male; Neuroleptic Malignant Syndrome; Olanzapine; Renal Dialysis; Tablets

Neuroleptic malignant syndrome is a rare neuropsychiatric complication caused by antipsychotic drugs. Symptoms include decreased consciousness, fever, muscle rigidity and autonomic dysfunction. Creatine kinase concentration is often elevated. This is a case report of a 27-year-old man who developed neuroleptic malignant syndrome after administration of olanzapine, risperidone and haloperidol. He was treated with benzodiazepine, dantrolene, amantadine and electroconvulsive therapy with good recovery.

Topics: Adult; Antipsychotic Agents; Haloperidol; Humans; Male; Neuroleptic Malignant Syndrome; Olanzapine; Risperidone

Neuroleptic malignant syndrome (NMS) is a life-threatening neurological emergency that is primarily characterized by altered consciousness, hyperpyrexia, muscular rigidity, and autonomic instability. Here, we describe a unique case of NMS. A 54-year-old woman with major depressive disorder (MDD) was admitted to our hospital to relieve painful emotions; her laboratory tests and physical examinations were unremarkable. Her medication regime was as follows: day 1, quetiapine (200 mg), clonazepam (2 mg), and zopiclone (7.5 mg); day 2, olanzapine (5 mg) and sertraline (100 mg); day 3, olanzapine (15 mg), sertraline (100 mg), zopiclone (7.5 mg), and clonazepam (2 mg); day 4, olanzapine (15 mg) and haloperidol (5 mg); and day 5, sertraline (50 mg) and olanzapine (5 mg). The patient then developed NMS, and a series of tests showed further abnormalities. Unusually, her cardiac troponin I (TNI) was abnormally elevated as her NMS symptoms worsened, but gradually decreased after she was transferred to the cardiology department for treatment. The increased TNI was suspected to be related to the NMS. Here, we provide several potential explanations for the relationship between TNI and NMS. Based on the present case, it may be important to measure and monitor TNI concentrations in NMS patients.

Topics: Antipsychotic Agents; Depressive Disorder, Major; Female; Humans; Middle Aged; Neuroleptic Malignant Syndrome; Olanzapine; Troponin I

Neuroleptic malignant syndrome (NMS) is a potentially fatal adverse effect of antipsychotics. Atypical presentation of NMS with drugs which are not potential D2 blockers raises question for an alternative hypothesis for NMS. A 30 year old male presented with irritability, assaultive behavior, persecutory delusion and auditory hallucination for three days. Past history of 3 similar episodes. 1st episode preceded by fever and associated with cerebral edema. Subsequent episodes not preceded by fever and patient was treated with Risperidone and Olanzapine. After admission patient was started on Risperidone along with THP when he had fever, tremors, altered sensorium and rigidity at 3 mg dose. After stopping Risperidone fever and rigidity improved with worsening of psychotic symptoms. Following this Olanzapine was started and very gradually uptitrated to 7.5 mg when patient had recurrence of fever and disorientation without tremors and minimal rigidity. Both the instances blood investigations including CPK levels were normal except for thrombocytopenia and leucopenia. Provisional impression of NMS was made in both instances. After stopping Olanzapine fever subsided with improvement of blood counts. Following this patient had catatonic symptoms for which patient received 9 sessions of Electroconvulsive therapy (ECT). In atypical presentations of NMS, hyperthermia and muscle rigidity may be absent, posing diagnostic dilemma. So there is a need for broadening the diagnostic criteria and NMS must be considered with a high index of suspicion.

Topics: Adult; Antipsychotic Agents; Humans; Male; Neuroleptic Malignant Syndrome; Olanzapine; Risperidone

Topics: Analgesics, Opioid; Anticonvulsants; Antipsychotic Agents; Benzodiazepines; Dantrolene; Diagnosis, Differential; Fentanyl; Haloperidol; Humans; Levetiracetam; Male; Middle Aged; Neuroleptic Malignant Syndrome; Olanzapine; Phenytoin; Piracetam

Topics: Adult; Benzodiazepines; Bipolar Disorder; Electroconvulsive Therapy; Humans; Male; Neuroleptic Malignant Syndrome; Olanzapine; Young Adult

A 27-year-old woman with panic disorder taking 20 mg olanzapine daily for 4 months was admitted to Mito Kyodo General Hospital, Mito, Ibaraki, Japan, because of disturbed consciousness with fever, hyperglycemia, hyperosmolarity and elevated creatine phosphokinase. She was diagnosed with a hyperosmolar hyperglycemic state and neuroleptic malignant syndrome. Brain magnetic resonance imaging showed transiently restricted diffusion in the splenium of the corpus callosum, with a high signal intensity on diffusion-weighted imaging. The neurological abnormalities disappeared along with improvement of metabolic derangements, and the follow-up magnetic resonance imaging carried out on the 26th day of admission showed complete resolution of the lesions in the splenium of the corpus callosum. These clinical and radiological features are highly suggestive of clinically mild encephalitis/encephalopathy with a reversible splenial lesion. The first case of mild encephalitis/encephalopathy with a reversible splenial lesion caused by olanzapine-induced hyperosmolar hyperglycemic state and neuroleptic malignant syndrome is reported.

Topics: Adult; Benzodiazepines; Corpus Callosum; Encephalitis; Female; Humans; Hyperglycemic Hyperosmolar Nonketotic Coma; Neuroleptic Malignant Syndrome; Olanzapine

Topics: Adolescent; Anorexia Nervosa; Antipsychotic Agents; Benzodiazepines; Humans; Male; Neuroleptic Malignant Syndrome; Olanzapine

A woman in her 60s with a history of hepatitis C with cirrhosis and major depressive disorder with psychotic features was admitted to the inpatient psychiatric unit for suicidal ideation. She was initially treated with a combination of sertraline and paliperidone. The paliperidone was subsequently changed to risperidone and ultimately to olanzapine. She developed worsening mental status and was then treated for catatonia with benzodiazepines. Over 2 days, her mental status continued to worsen and she developed fever and tachycardia. She was transferred to the ICU and endotracheally intubated for inability to protect her airway. She was started on lactulose via orogastric tube but showed no improvement in her mental status after 2 days despite having two or three bowel movements per day.

Topics: Antipsychotic Agents; Benzodiazepines; Depressive Disorder, Major; Diagnosis, Differential; Female; Humans; Intensive Care Units; Middle Aged; Neuroleptic Malignant Syndrome; Olanzapine

We present the case of a middle-aged man with a chronic history of schizoaffective disorder, depressed type, stable on a second-generation antipsychotic. Psychotic symptoms recurred contingent to medication noncompliance necessitating hospitalization. Treatment was complicated by the development of neuroleptic malignant syndrome (NMS). In addition, subsequent medication rechallenges failed because of recurrent rhabdomyolysis and atypical NMS. Electroconvulsive therapy (ECT) treatment was initiated, affording remission of psychotic symptoms and nonrecurrence of NMS and rhabdomyolysis. Our experience confirmed the efficacy of ECT treatment in providing symptom relief of psychosis complicated by recurrent episodes of NMS and atypical NMS. Likewise, it illustrated the efficacy of ECT treatment for rhabdomyolysis.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Clozapine; Electroconvulsive Therapy; Humans; Male; Neuroleptic Malignant Syndrome; Olanzapine; Patient Compliance; Rhabdomyolysis; Schizophrenia; Treatment Outcome

Neuroleptic malignant syndrome (NMS) is a rare life-threatening disorder resulting from treatment with neuroleptic agents and other drugs that act as dopamine antagonists. NMS most often occurs shortly after the initiation, dose increase or withdrawal of the offending agent, but can rarely occur after long-term treatment at stable doses. Immediate discontinuation of the causative agent (or re-administration if the cause is the withdrawal of neuroleptic therapy) along with supportive therapy to maintain cardiorespiratory stability and to reduce fever are the cornerstone of the management of NMS. Additional 'specific' treatments include dantrolene, bromocriptine and amantadine, but their role in the management of NMS is controversial.. This study reports the case of NMS associated with long-term treatment with olanzapine at a stable dose. Administration of dantrolene was well-tolerated and resulted in prompt resolution of NMS symptoms.

Topics: Aged, 80 and over; Benzodiazepines; Dantrolene; Female; Humans; Neuroleptic Malignant Syndrome; Olanzapine

In 2012, Danish psychiatrist raised concerns regarding the use of high-dose olanzapine in the treatment of patients. The present study was part of an audit carried out by the Mental Health Services of the Capitol Region of Denmark regarding this topic. Objective. To assess the potential risks associated with high-dose olanzapine treatment (> 40 mg daily) in inpatient psychiatric units.. The study was an observational case series based on review of patient charts. The main inclusion criterion was treatment with at least one daily dose > 40 mg olanzapine during the index admission in the period between 1st of January and 15th of March 2012. Six additional criteria were applied in order to target the subgroup of patients most likely to have experienced an adverse event due to treatment with olanzapine. The physician order entry system and the central patient register containing patient specific information about diagnoses and treatments were used for identification of study population.. The 91 patients included in the study received maximum daily doses of olanzapine ranging from 45 to 160 mg and in 25% of patients, the total antipsychotic load exceeded 2000 mg of chlorpromazine equivalents. Extrapyramidal symptoms and sedation were the most frequent adverse events with frequencies of 27% and 25%, respectively. Furthermore, other well-known adverse events such as weight gain (14%), hypotension (2%), neuroleptic malignant syndrome (2%) and corrected QT-interval (QTc) prolongation (1%) were also observed in some patients. Five patients died and in two of these cases, olanzapine was concluded to be a possible contributing cause of death.. Increased frequency of extrapyramidal symptoms and sedation as well as severe toxicity was observed in patients treated with up to 160 mg olanzapine per day. In order to prevent harmful outcomes, the clinicians should be ready to act appropriately if toxic effects of olanzapine occur. Treatment cessation should be immediate if serious adverse events such as neuroleptic malignant syndrome arise.

Topics: Adult; Antipsychotic Agents; Basal Ganglia Diseases; Benzodiazepines; Central Nervous System; Denmark; Depression, Chemical; Drug Overdose; Electrocardiography; Female; Hospitals, Psychiatric; Humans; Inpatients; Long QT Syndrome; Male; Neuroleptic Malignant Syndrome; Olanzapine; Psychotic Disorders; Retrospective Studies; Risk Assessment

Neuroleptic malignant syndrome (NMS) can be caused by various drugs. We report a case of a 60-year-old woman who presented with high-grade fever, muscular rigidity, tachycardia, tachypnoea and altered sensorium along with seizures. She had been taking olanzapine for the past 2 years for psychosis. For the last month valproate was added to her treatment. Her blood investigations revealed hyponatraemia and raised serum ammonia and creatinine phosphokinase (CPK) levels. In view of hyperthermia, muscular rigidity, autonomic disturbances, altered mental status and raised CPK, a diagnosis of NMS was made. Valproate could have probably precipitated NMS; although the patient was taking antipsychotics for a long time, it was only with the addition of valproate that she developed these symptoms. Raised serum ammonia levels also indicated the presence of valproate toxicity. Seizures were probably due to electrolyte disturbances. Offending drugs were withdrawn. The patient improved with treatment by dopamine agonist and other supportive treatments.

Topics: Anticonvulsants; Antipsychotic Agents; Benzodiazepines; Benzothiazoles; Dopamine Agonists; Drug Therapy, Combination; Female; Fluid Therapy; Humans; Levetiracetam; Lorazepam; Middle Aged; Neuroleptic Malignant Syndrome; Olanzapine; Piracetam; Pramipexole; Psychotic Disorders; Valproic Acid

A 64-year-old man, diagnosed with recurrent depression, developed a neuroleptic malignant syndrome (nms) during treatment with olanzapine and mirtazapine. Psychotropic drugs were discontinued. Supportive therapy in an intensive care setting was initiated and electroconvulsive therapy (ect) was administered, after which the patient recovered. This case report discusses the place of ect in the treatment of nms.

Topics: Antipsychotic Agents; Benzodiazepines; Depressive Disorder; Electroconvulsive Therapy; Humans; Male; Mianserin; Middle Aged; Mirtazapine; Neuroleptic Malignant Syndrome; Olanzapine

Topics: Adolescent; Adult; Amisulpride; Anticonvulsants; Antipsychotic Agents; Benzodiazepines; Carbamazepine; Drug Therapy, Combination; Female; Humans; Male; Neuroleptic Malignant Syndrome; Olanzapine; Sulpiride; Valproic Acid

Topics: Antipsychotic Agents; Benzodiazepines; Fatal Outcome; Humans; Middle Aged; Neuroleptic Malignant Syndrome; Olanzapine; Schizophrenia, Paranoid

The frequency of severe adverse drug reactions (ADRs) from psychotropic drugs was investigated in hospitalised psychiatric patients in relation to their age. Specifically, the incidence of ADRs in patients up to 60 years was compared to that of patients older than 60 years.. Prescription rates of psychotropic drugs and reports of severe ADRs were collected in psychiatric hospitals in Switzerland between 2001 and 2010. The data stem from the drug surveillance programme AMSP.. A total of 699 patients exhibited severe ADRs: 517 out of 28,282 patients up to 60 years (1.8%); 182 out of 11,446 elderly patients (1.6%, ns). Logistic regression analyses showed a significantly negative relationship between the incidence of ADRs and patients' age in general and in particular for weight gain, extrapyramidal motor system (EPMS) symptoms, increased liver enzymes and galactorrhoea. A significantly negative relationship was observed for age and the dosages of olanzapine, quetiapine, risperidone, valproic acid and lamotrigine. When comparing age groups, frequency of ADRs was lower in general for antipsychotic drugs and anticonvulsants, in particular for valproic acid in the elderly. Weight gain was found to be lower in the elderly for antipsychotic drugs, in particular for olanzapine. For the group of mood-stabilising anticonvulsants (carbamazepine, lamotrigine and valproic acid) the elderly exhibited a lower incidence of reported allergic skin reactions.. The results suggest that for psychiatric inpatients the incidence of common severe ADRs (e.g., weight gain or EPMS symptoms) arising from psychotropic medication decreases with the age of patients.

Topics: Adolescent; Adult; Adverse Drug Reaction Reporting Systems; Age Factors; Aged; Aged, 80 and over; Antimanic Agents; Antipsychotic Agents; Basal Ganglia Diseases; Benzodiazepines; Carbamazepine; Causality; Dibenzothiazepines; Drug-Related Side Effects and Adverse Reactions; Female; Galactorrhea; Humans; Lamotrigine; Logistic Models; Male; Middle Aged; Neuroleptic Malignant Syndrome; Olanzapine; Quetiapine Fumarate; Risperidone; Severity of Illness Index; Switzerland; Triazines; Valproic Acid; Weight Gain; Young Adult

Topics: Antimanic Agents; Antipsychotic Agents; Benzodiazepines; Creatine Kinase; Haloperidol; Humans; Influenza A Virus, H1N1 Subtype; Male; Middle Aged; Neuroleptic Malignant Syndrome; Olanzapine; Pneumonia, Viral; Schizophrenia; Treatment Outcome; Valproic Acid; Withholding Treatment

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Delusions; Humans; Huntington Disease; Male; Neuroleptic Malignant Syndrome; Olanzapine

Topics: Benzodiazepines; Female; Humans; Lewy Body Disease; Middle Aged; Neuroleptic Malignant Syndrome; Olanzapine

Atypical antipsychotic drugs (AADs) are the standard treatment for both the acute and long-term management of schizophrenia and an augmentation to mood stabilizers for bipolar disorder (BD). Yet many individuals who take AADs do not fully respond to them, while others experience side effects that include weight gain and metabolic disorder. This in vitro pharmacogenetic study examined whether allelic variants in the 5-hydroxytryptamine (HT)(2A) receptor alter the in vitro pharmacology of six AADs (clozapine, olanzapine, risperidone, quetiapine, ziprasidone, and aripiprazole). We selected 4 functional single-nucleotide polymorphisms (SNPs) for investigation (Thr25Asn, Ile197Val, Ala447Val, and His452Tyr), conducted site-directed mutagenesis studies to induce variants into human HEK-293 cell lines, and screened allelic variants for their effects on 5-HT( 2A) receptors in the cell lines. We conducted numerous binding assays and fluorescence-based assay system (FLEX station) experiments using the six AADs. Our results indicated that three polymorphic 5-HT(2A) receptors (Ile197Val, Ala447Val, and His452Tyr) exhibited statistically significant, though modest, changes in atypical antipsychotic affinity. In addition, three polymorphic receptors (Thr25Asn, Ile197Val, and His452Try) altered AAD potency. Our findings support in vivo evidence that functional SNPs in genes encoding neuroreceptor drug targets could explain interindividual differences in AAD drug response and tolerability. We suggest that more in vivo pharmacogenetic studies of well-characterized patients who are prescribed AADs be indicated. Future pharmacogenetic studies of well-characterized patients will likely involve tagging SNPs and the use of haplotypes related to other genes encoding neuroreceptor drug targets.

Topics: Antipsychotic Agents; Aripiprazole; Benzodiazepines; Clozapine; Dibenzothiazepines; Drug Resistance; HEK293 Cells; Humans; Mutagenesis, Site-Directed; Neuroleptic Malignant Syndrome; Nursing Research; Olanzapine; Pharmacogenetics; Piperazines; Polymorphism, Single Nucleotide; Quetiapine Fumarate; Quinolones; Receptor, Serotonin, 5-HT2A; Risperidone; Thiazoles

Topics: Acute Kidney Injury; Aged, 80 and over; Antipsychotic Agents; Benzodiazepines; Fever; Humans; Hydrotherapy; Male; Neuroleptic Malignant Syndrome; Olanzapine; Ramipril

To describe a case of neuroleptic malignant syndrome (NMS) associated with the use of prochlorperazine in a patient recently hospitalized for NMS secondary to olanzapine.. A 28-year-old African American male with a history of schizophrenia was hospitalized 22 days prior to the current admission for an episode of olanzapine-induced NMS. The patient was discharged from our hospital to an outside psychiatric facility. At this facility, the patient developed nausea and was given 2 doses (unknown amount and route) of prochlorperazine. Over the next 24 hours, the patient exhibited signs and symptoms of NMS including fever, agitation, and muscle rigidity. He was transported to the emergency department and became increasingly agitated. Upon admission, the patient was hyperthermic (rectal temperature 39 °C) and tachycardic (heart rate 138 beats/min), with an elevated white blood cell count of 13.5 × 10(3)/μL, creatine kinase 431 units/L, serum sodium 150 mEq/L, blood urea nitrogen 25 mg/dL, and creatinine 1.1 mg/dL. A diagnosis of NMS was speculated and infectious causes were excluded. The patient was treated with aggressive fluid resuscitation and rapid cooling measures, as well as bromocriptine and lorazepam. Cooling measures were used for 48 hours, during which time the creatine kinase, white blood cell count, sodium, blood urea nitrogen, and creatinine gradually normalized. The patient was discharged to a psychiatry facility with a treatment regimen of oxcarbazepine 600 mg twice daily, lorazepam 2 mg 3 times daily, and clozapine 25 mg at bedtime, which was titrated over 2 months to 200 mg twice daily. There have been no further occurrences of NMS.. The patient had all of the major characteristics of NMS with no other likely causative factors that may have contributed to his illness. Use of the Naranjo probability scale suggested that NMS was probably related to prochlorperazine. This case highlights the potential increased risk with the use of prochlorperazine in a patient with a history of olanzapine-induced NMS.. NMS should be considered as a rare complication of therapy with antipsychotics and agents that alter dopamine activity, especially in patients with a history of the syndrome. Careful consideration should be given regarding the risks and benefits of using non-antipsychotic dopamine antagonists in patients with a history of antipsychotic-induced NMS.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Humans; Male; Neuroleptic Malignant Syndrome; Olanzapine; Prochlorperazine; Schizophrenia

Although the relationship between antipsychotic medication, particularly second-generation antipsychotics (SGAs), and metabolic disturbance is increasingly accepted, there is an important, but little recognised, potential interaction between this and the other important serious adverse effect of neuroleptic malignant syndrome (NMS). We report a case of a 35-year old female who developed new onset type II diabetes mellitus with hyperosmolar hyperglycaemic coma and acute renal failure following treatment with a SGA for a first manic episode. The history is strongly suggestive of concurrent NMS. This case raises important questions about non-ketotic, hyperosmolar diabetic coma with antipsychotics, the possible association between hyperglycaemia and hyperthermia, and the direction of causality in this, the recognition of either syndrome when they co-exist and management issues in such patients. These questions are considered in the context of currently available literature.

Topics: Acute Kidney Injury; Adult; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Diabetes Mellitus, Type 2; Female; Humans; Hyperglycemic Hyperosmolar Nonketotic Coma; Neuroleptic Malignant Syndrome; Olanzapine

We report a case of severe neuroleptic malignant syndrome developing in a 28-year-old female patient following deliberate self-poisoning with atypical antipsychotic drugs and serotonin reuptake inhibitors. Because of an increasing loss of consciousness she was rapidly transferred to an Intensive Care Unit. Following this, she became progressively febrile associated with rhabdomyolysis and life-threatening organ dysfunctions. Due to fast diagnosis and immediate therapy the patient was treated successfully. This article describes etiology, pathophysiology and symptoms of neuroleptic malignant syndrome. In addition therapeutic options are discussed.

Topics: Adult; Antidepressive Agents; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Coma; Creatine Kinase; Critical Care; Dantrolene; Female; Humans; Muscle Relaxants, Central; Myoglobin; Neuroleptic Malignant Syndrome; Olanzapine; Sertraline; Treatment Outcome

A case of a male patient with schizophrenic illness who developed neuroleptic malignant syndrome (NMS) following treatment with olanzapine is reported. Although typical neuroleptics are more frequently associated with NMS, atypical antipsychotics may also cause NMS. Case reports have been published concerning NMS and clozapine,(1) risperidone(2) and olanzapine.(3-6) This case report emphasizes the importance of being cautious when rapidly increasing doses of olanzapine are used in patients with psychiatric illnesses.

Topics: Antipsychotic Agents; Benzodiazepines; Consciousness; Humans; Hypnotics and Sedatives; Lorazepam; Male; Middle Aged; Neuroleptic Malignant Syndrome; Olanzapine; Schizophrenia, Paranoid; Tomography, X-Ray Computed

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.. 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.. 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.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Bromocriptine; Chlorpromazine; Citalopram; Combined Modality Therapy; Dopamine Agonists; Drug Overdose; Female; Humans; Hypnotics and Sedatives; Hypothermia, Induced; Infusions, Intravenous; Midazolam; Neuroleptic Malignant Syndrome; Olanzapine; Respiration, Artificial; Treatment Outcome

Topics: Antipsychotic Agents; Benzodiazepines; Bromocriptine; Chlorpromazine; Disease Progression; Dopamine Agonists; Drug Overdose; Humans; Neuroleptic Malignant Syndrome; Olanzapine; Serotonin Receptor Agonists; Treatment Outcome

Topics: Adult; Aggression; Antipsychotic Agents; Aripiprazole; Benzodiazepines; Benztropine; Dose-Response Relationship, Drug; Drug Therapy, Combination; Humans; Intellectual Disability; Male; Neuroleptic Malignant Syndrome; Neurologic Examination; Olanzapine; Piperazines; Quinolones; Risk Factors

A 78-year-old man with a 22-year history of schizoaffective disorder and a 5-year history of dementia presented to the emergency department with a 5-day history of fatigue, progressive weakness, confusion and lethargy, and a 1-day history of severe muscle stiffness. For the past 10 years the patient had been treated with olanzapine for an unspecified psychiatric illness, without adverse effects. One week before presentation the patient was started on donepezil to treat mild dementia.. Physical examination, serum and urine laboratory evaluation, lumbar puncture, brain CT scan, brain MRI, electroencephalogram, chest X-ray, and electrocardiogram.. A variant of neuroleptic malignant syndrome secondary to drug interaction.. Discontinuation of donepezil and olanzapine, aggressive intravenous hydration, intravenous dantrolene, and bromocriptine via a nasogastric tube. The patient was also administered intravenous antibiotics for aspiration pneumonia, and carbidopa-levodopa for residual parkinsonian features.

Topics: Aged; Benzodiazepines; Cholinesterase Inhibitors; Donepezil; Humans; Indans; Male; Neuroleptic Malignant Syndrome; Olanzapine; Piperidines; Selective Serotonin Reuptake Inhibitors

Topics: Acute Kidney Injury; Antipsychotic Agents; Benzodiazepines; Electroencephalography; Female; Fluphenazine; Humans; Middle Aged; Neuroleptic Malignant Syndrome; Olanzapine; Psychotic Disorders

Neuroleptic malignant syndrome (NMS) is an idiosyncratic and uncommon but serious adverse effect that has been reported with both typical and atypical antipsychotic agents. We describe a 58-year-old man with Down syndrome and dementia who was receiving low-dose olanzapine and rivastigmine therapy; he developed NMS 4 months after starting olanzapine. The patient presented with altered mental status, rigidity, fever, diaphoresis, and tremor, and his creatine kinase level was elevated. Olanzapine was discontinued, and the patient fully recovered; antipsychotic therapy was not restarted. Based on the Naranjo adverse drug reaction probability scale, olanzapine was the probable cause of the patient's NMS. In addition, use of rivastigmine in combination with olanzapine may have placed the patient at greater risk for NMS, possibly due to an acetylcholine-dopamine imbalance. Clinicians should be aware of the potential for NMS even with low doses of antipsychotics, particularly in patients who have a limited ability to communicate. Concomitant administration of cholinesterase inhibitors such as rivastigmine may represent an unrecognized risk factor for NMS development.

Topics: Antipsychotic Agents; Benzodiazepines; Cholinesterase Inhibitors; Dementia; Down Syndrome; Humans; Male; Middle Aged; Neuroleptic Malignant Syndrome; Olanzapine; Phenylcarbamates; Rivastigmine

Topics: Adolescent; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Humans; Male; Neuroleptic Malignant Syndrome; Olanzapine

Topics: Administration, Oral; Adolescent; Antipsychotic Agents; Benzodiazepines; Chlorpromazine; Diagnosis, Differential; Dibenzothiazepines; Drug Therapy, Combination; Humans; Injections, Intramuscular; Male; Neuroleptic Malignant Syndrome; Olanzapine; Paranoid Disorders; Quetiapine Fumarate

Topics: Aged; Anti-Anxiety Agents; Antipsychotic Agents; Benzodiazepines; Catatonia; Chlorpromazine; Cholinesterase Inhibitors; Cognition Disorders; Creatine Kinase; Dementia; Disease Progression; Donepezil; Female; Humans; Indans; Lorazepam; Muscle Rigidity; Neuroleptic Malignant Syndrome; Olanzapine; Piperidines; Recurrence; Risperidone

Topics: Antipsychotic Agents; Benzodiazepines; Diagnosis, Differential; Humans; Male; Neuroleptic Malignant Syndrome; Olanzapine; Patient Compliance; Patient Discharge; Piperazines; Schizophrenia; Schizophrenic Psychology; Thiazoles; Treatment Outcome

Topics: Antipsychotic Agents; Benzodiazepines; Humans; Male; Middle Aged; Neuroleptic Malignant Syndrome; Olanzapine; Psychotic Disorders

Neuroleptic malignant syndrome (NMS) is the most serious of acute neurological side effects produced by antipsychotic medication, characterized by hyperthermia, rigidity, altered consciousness and autonomic dysfunction, the prevalence of which varies from 0.4-1.4%. NMS is usually seen in treatment with high potency typical antipsychotics and very rarely with atypical antipsychotics. However, NMS cases have been reported with risperidone, clozapine, olanzapine and quetiapine. The presentations of NMS have often varied and we report another atypicality in presentation of NMS due to olanzapine use.

Topics: Acute Disease; Adult; Antipsychotic Agents; Benzodiazepines; Humans; Male; Neuroleptic Malignant Syndrome; Olanzapine

Neuroleptic malignant syndrome (NMS) is an uncommon but sometimes fatal complication of neuroleptics and other medications that involve the central dopaminergic system. Many diagnostic criteria have been proposed for NMS but because of its variable presentation, universal criteria have not been established yet. Hyperthermia, disturbances of consciousness, extrapyramidal and autonomic symptoms are common features of NMS. We report the case of a 36 years old woman suffering from chronic schizophrenia and treated with flufenazine and olanzapine, who presented with series of generalised tonic-clonic seizures as the acute onset of recurrent malignant neuroleptic syndrome. Although atypical neuroleptics were previously thought to have less risk for MNS, combination of conventional and atypical neuroleptics in therapy increases the risk of NMS development and olanzapine might be responsible for the epileptic manifestations at the onset of fulminant NMS.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Chronic Disease; Drug Therapy, Combination; Early Diagnosis; Electroencephalography; Epilepsy, Generalized; Fluphenazine; Humans; Male; Neuroleptic Malignant Syndrome; Olanzapine; Recurrence; Risk Factors; Schizophrenia; Seizures

Neuroleptic malignant syndrome (NMS) is a rare but potentially serious complication of neuroleptic drugs. It may vary in both presenting characteristics and severity. Several different criteria for diagnosis exist, and each differs from the others slightly. We describe a 66-year-old woman with chronic paranoid schizophrenia who was prescribed olanzapine along with several other psychiatric drugs and an antihypertensive drug. The patient displayed several characteristics of NMS during therapy with olanzapine, including fever, elevated creatine kinase level, leukocytosis, and mild muscle rigidity. When olanzapine was held, the signs and symptoms improved and then returned with rechallenge of olanzapine. For this reason, olanzapine was considered strongly associated with this patient's apparent NMS episode. The patient's beta-blocker therapy may have masked additional signs of NMS. In addition, the patient tolerated other neuroleptics that were started in the hospital after the suspected NMS episode. The variation among different diagnostic criteria makes this syndrome a challenging diagnosis at times, in particular when atypical antipsychotics are suspected as the causative agent.

Topics: Aged; Antipsychotic Agents; Benzodiazepines; Female; Humans; Neuroleptic Malignant Syndrome; Olanzapine; Schizophrenia, Paranoid

Topics: Adolescent; Amnesia; Antipsychotic Agents; Benzodiazepines; Humans; Male; Neuroleptic Malignant Syndrome; Olanzapine; Psychotic Disorders

A 79-year-old nursing home resident who was taking olanzapine presented to multiple hospitals with fevers of unknown origin. After an extensive workup to rule out infection, the patient was diagnosed as having neuroleptic malignant syndrome (NMS). This patient's presentation was atypical because of the lack of rigidity or tremor at the time of admission. This case highlights the importance of including NMS in the differential diagnosis of fever of unknown origin in medical patients. A review of the medical literature is taken, focusing on diagnoses, prevalence, predisposing factors, pathophysiology, and current treatment approaches for NMS.

Topics: Aged; Antipsychotic Agents; Benzodiazepines; Diagnosis, Differential; Fever of Unknown Origin; Humans; Male; Neuroleptic Malignant Syndrome; Olanzapine

Neuroleptic Malignant Syndrome (NMS) is a rare, potentially fatal and idiosyncratic drug reaction. It is characterized by a sudden loss of body temperature control, renal and respiratory failure, muscle rigidity, loss of consciousness and impairment of autonomic nervous system. Although NMS was previously associated with the use of classical high-potency neuroleptics, cases have started to emerge with atypical neuroleptics. This article discusses the first case of NMS in a child, induced by the use of risperidone, olanzapine and quetiapine.

Topics: Aggression; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Body Temperature; Child; Dibenzothiazepines; Electroconvulsive Therapy; Female; Humans; Impulsive Behavior; Neuroleptic Malignant Syndrome; Olanzapine; Quetiapine Fumarate; Risperidone; Valproic Acid; Violence

Neuroleptic malignant syndrome (NMS) is a rare syndrome with four main symptoms: rigidity, hyperthermia, altered mental status and autonomic instability. We report a patient with an atypical manifestation of NMS.. A single case was reported.. A patient with pneumonia developed delirium and was treated with olanzapine and developed a NMS with fluctuating hyperthermia and autonomic instability during a month. Only slight rigidity was present. Creatine kinase was not elevated. The patient was severely agitated and manic. After discontinuation of olanzapine the patient showed no psychopathology or hyperthermia.. NMS should be considered when patients treated with antipsychotics develop one or more symptoms of NMS.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Delirium; Female; Humans; Neuroleptic Malignant Syndrome; Olanzapine

Topics: Administration, Oral; Adolescent; Antipsychotic Agents; Benzodiazepines; Child; Child Development Disorders, Pervasive; Clozapine; Creatine Kinase; Dose-Response Relationship, Drug; Drug Interactions; Drug Therapy, Combination; Humans; Injections, Intramuscular; Male; Neuroleptic Malignant Syndrome; Olanzapine; Schizophrenia

The incidence of neuroleptic malignant syndrome (NMS) is not known, but the frequency of its occurrence with conventional antipsychotic agents has been reported to vary from 0.02% to 2.44%.. MEDLINE search conducted in January 2003 and review of references within the retrieved articles.. Our MEDLINE research yielded 68 cases (21 females and 47 males) of NMS associated with atypical antipsychotic drugs (clozapine, N = 21; risperidone, N = 23; olanzapine, N = 19; and quetiapine, N = 5). The fact that 21 cases of NMS with clozapine were found indicates that low occurrence of extrapyramidal symptoms (EPS) and low EPS-inducing potential do not prevent the occurrence of NMS and D(2) dopamine receptor blocking potential does not have direct correlation with the occurrence of NMS. One of the cardinal features of NMS is an increasing manifestation of EPS, and the conventional antipsychotic drugs are known to produce EPS in 95% or more of NMS cases. With atypical antipsychotic drugs, the incidence of EPS during NMS is of a similar magnitude.. For NMS associated with atypical antipsychotic drugs, the mortality rate was lower than that with conventional antipsychotic drugs. However, the mortality rate may simply be a reflection of physicians' awareness and ensuing early treatment.

Topics: Adult; Aged; Antipsychotic Agents; Benzodiazepines; Bromocriptine; Clozapine; Dantrolene; Dibenzothiazepines; Dopamine Agonists; Female; Humans; Intubation; Male; MEDLINE; Mental Disorders; Middle Aged; Muscle Relaxants, Central; Neuroleptic Malignant Syndrome; Olanzapine; Quetiapine Fumarate; Respiration, Artificial; Risperidone; Treatment Outcome

Neuroleptic malignant syndrome (NMS) is an uncommon potentially fatal side effect of neuroleptic drugs, characterized by movement disorder, altered mental status and autonomic instability. A single dose of clotiapine was administered to an 11-year old male with acute psychosis. The previously healthy child had signs consistent with NMS including hyperthermia, hypertension, motor and mental changes. Repeat examination performed two weeks later, demonstrated that while his hyperthermia subsided, his mental status deteriorated. Olanzapine was administered, after which the child had hyperthermia, dystonia and more pronounced restlessness, once again consistent with NMS. He developed respiratory failure and was intubated and mechanically ventilated. Lorazepam, dantrolene and bromocriptine were administered as treatment of possible NMS. His mental condition, movement disorder and autonomic dysfunction improved significantly. Two weeks later, the patient was discharged in good general condition without the need for any ongoing medical treatment. There are only few case reports of NMS in children treated with olanzapine, an atypical antipsychotic. In children, caution must be exercised when prescribing antipsychotics, particularly atypical antipsychotics as these drugs may cause NMS. Because of the low incidence of NMS, a high index of suspicion is needed to identify cases so prompt treatment can be undertaken.

Topics: Acute Disease; Anticonvulsants; Antipsychotic Agents; Benzodiazepines; Blood Cell Count; Child; Dibenzothiazepines; Electroencephalography; False Positive Reactions; Humans; Magnetic Resonance Imaging; Male; Neuroleptic Malignant Syndrome; Neurologic Examination; Olanzapine; Phenytoin; Prion Diseases; Psychotic Disorders

A 17-year-old African-American male developed neuroleptic malignant syndrome (NMS) with hyperthermia, autonomic instability, increased muscle tone, rhabdomyolysis, and obtundation after a maximum of 2 days of treatment with olanzapine and 1 day of treatment with divalproex sodium. Intensive care unit (ICU)-level care was required. Paranoid psychosis with catatonia was present after recovery from the NMS. Because of his continued psychotic symptoms following resolution of the NMS, the alternate atypical antipsychotic, clozapine, was started under close observation. Reports of NMS resulting from atypical antipsychotic agents are generally uncommon, and much more so in the child and adolescent population. However, these agents are frequently prescribed in this population and require due caution.

Topics: Adolescent; Benzodiazepines; Clozapine; Humans; Male; Neuroleptic Malignant Syndrome; Olanzapine

Topics: Aged; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Dopamine; Humans; Male; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine; Psychiatric Status Rating Scales

Topics: Aged; Aged, 80 and over; Antipsychotic Agents; Benzodiazepines; Dementia; Dose-Response Relationship, Drug; Hot Temperature; Humans; Male; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Creatine Kinase; Creatine Kinase, MB Form; Diagnosis, Differential; Humans; Isoenzymes; Male; Middle Aged; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine; Stimulation, Chemical

Rhabdomyolysis is a disorder characterized by skeletal muscle injury and fatal complications at times. The causes of rhabdomyolysis are usually traumatic and non-traumatic, such as neuroleptic malignant syndrome and rhabdomyolysis associated to septicemia. The cases of 2 schizophrenic patients with rhabdomyolisis during pneumonia infection and neuroleptic therapy are reported. At admission, both patients had important respiratory distress and hyperthermia; the clinical conditions required endotracheal intubation. Blood and urine cultures were always negative, while the bronchial sputum culture was positive. The diagnosis of rhabdomyolysis was confirmed by myoglobinemia dosage and ortholuidine test. Pneumonia infection was treated with antibiotic specific therapy whereas renal failure was treated with adequate hydratation and strained diuresis. The absence of muscle rigidity, the improvement of X-r images and the reduction of corporeal temperature, during antibiotic treatment, excluded neuroleptic malignant syndrome. The impro-vement allowed extubation and discharge of the patients from intensive care unit. In both cases neuroleptic malignant syndrome was excluded, therefore rhabdomyolysis was the consequence of pneumonia infection or of a combination of factors capable to cause an important damage of skeletal muscles.

Topics: Acute Kidney Injury; Adult; Antipsychotic Agents; Benzodiazepines; Diagnosis, Differential; Fever; Humans; Male; Middle Aged; Muscle Rigidity; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine; Pneumonia, Bacterial; Rhabdomyolysis; Risperidone; Schizophrenia

Neuroleptic malignant syndrome is a potentially fatal reaction to antipsychotic drugs, characterised by hyperthermia, rigidity, autonomic instability and muscle injury. The syndrome was originally associated with traditional neuroleptics, but may also occur during treatment with second-generation atypical antipsychotic drugs.. We present a case of neuroleptic malignant syndrome in a 52-year-old patient who had been treated for 2(1/2) years with olanzapine, a new atypical antipsychotic agent. He had previously been treated with a conventional neuroleptic for 25 years.. For 2-3 days the patient's condition was serious and unstable, requiring care in the emergency unit. When he was discharged after 12 days' hospitalisation, he was still physically disabled and needed care in his home.. Neuroleptic malignant syndrome may develop even after long and stable treatment with atypical antipsychotic agents. The condition should be suspected in psychiatric patients who present with unclear hyperthermia and muscular rigidity. Essential therapeutic principles are cooling, rehydration, correction of electrolytic disturbances, cardiac monitoring, regular tests of renal function and creatine kinase. Treatment of malign hyperthermia with dantrolene should also be considered.

Topics: Antipsychotic Agents; Benzodiazepines; Humans; Male; Middle Aged; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine; Selective Serotonin Reuptake Inhibitors

Topics: Benzodiazepines; Drug Therapy, Combination; Female; Humans; Middle Aged; Neuroleptic Malignant Syndrome; Olanzapine; Paroxetine; Selective Serotonin Reuptake Inhibitors

Topics: Antipsychotic Agents; Benzodiazepines; Drug Therapy, Combination; Fluphenazine; Humans; Male; Middle Aged; Neuroleptic Malignant Syndrome; Olanzapine

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Catatonia; Diagnosis, Differential; Electroconvulsive Therapy; Humans; Male; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine; Treatment Outcome

A 17-year-old adolescent female presented to a psychiatric emergency room with excitement, confusion, and psychotic symptoms. After brief exposure to haloperidol and olanzapine, she developed fever, rigidity, waxy flexibility, autonomic instability, and elevated creatinine phosphokinase enzyme. Approximately 6 weeks after the onset of the illness, multiple laboratory tests, and evaluation at three different hospitals, the condition was effectively treated with electroconvulsive therapy (ECT). This case is a lesson in delayed recognition and the delayed use of ECT for the malignant catatonia/neuroleptic malignant syndrome.

Topics: Adolescent; Benzodiazepines; Brain; Catatonia; Diagnosis, Differential; Diagnostic Imaging; Electroconvulsive Therapy; Electroencephalography; Female; Haloperidol; Humans; Neuroleptic Malignant Syndrome; Neurologic Examination; Neuropsychological Tests; Olanzapine; Pirenzepine; Treatment Outcome

We describe here a case of olanzapine associated weight gain, hyperglycemia and neuroleptic malignant syndrome in a 64 year-old woman with a significant medical history. Eighteen weeks after initiating olanzapine, Mrs X lost glycemic control, exhibited signs and symptoms consistent with neuroleptic malignant syndrome and gained 8.9 kg. We suggest that utilization of olanzapine in the less medically stable geriatric patient be implemented with vigilant monitoring for such complications mentioned above.

Topics: Antipsychotic Agents; Benzodiazepines; Female; Humans; Hyperglycemia; Middle Aged; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine; Weight Gain

Neuroleptic malignant syndrome (NMS) is a potentially life-threatening adverse effect of antipsychotic agents. It generally is characterized by fever, altered mental status, rigidity, and autonomic dysfunction. A 53-year-old man developed NMS without rigidity while taking olanzapine. Such atypical cases may support either a spectrum concept of NMS or the theory that NMS secondary to atypical antipsychotics differs from that caused by conventional neuroleptics. More flexible diagnostic criteria than currently mandated by the the Diagnostic and Statistical Manual of Mental Disorders, Fourth Revision, may be warranted.

Topics: Antipsychotic Agents; Benzodiazepines; Blood Cell Count; Hallucinations; Humans; Male; Middle Aged; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine; Schizophrenia, Paranoid; Schizophrenic Psychology

Neuroleptic malignant syndrome (NMS) is a rare and potentially fatal complication precipitated by the use of antipsychotic medications, most notably haloperidol. Criteria previously described include: exposure to the neuroleptic class of medications; hyperthermia; muscle rigidity; a cluster of laboratory and physical findings that may include mental status changes, autonomic instability, creatine phosphokinase elevation and leukocytosis, and exclusion of other causes for the patient's condition. A prodrome of mental status changes, autonomic instability, tremors, diaphoresis, excess salivation, and extrapyramidal signs may precede NMS. Prior reports of NMS linked to olanzapine have been in patients who had been previously treated with other neuroleptic agents or in patients who had previous episodes of NMS precipitated by other neuroleptics. Several cases included patients treated with olanzapine in addition to another neuroleptic. This report describes a case of NMS associated with olanzapine in a patient who had not previously been exposed to the neuroleptic drug class. At the time this patient presented, there were no reports in the literature of NMS associated with olanzapine alone. Treatment of NMS includes: immediate withdrawal of all neuroleptics; supportive care; fever control; management of autonomic instability (tachycardia, tachypnea, blood pressure fluctuations); and pharmacologic management with dantrolene and bromocriptine.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Female; Humans; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine; Psychomotor Agitation

Topics: Acute Disease; Adult; Antipsychotic Agents; Benzodiazepines; Drug Therapy, Combination; Emergency Service, Hospital; Female; Haloperidol; Humans; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine; Schizophrenia

We present the case of a 31-year-old woman with recent refractory bipolar disorder who developed a malignant syndrome preceded by catatonic motor features. This resistant case of lethal catatonia responded selectively to high-dose olanzapine treatment. The case illustrates the need to consider lethal catatonia in apparent cases of neuroleptic malignant syndrome that do not respond to conventional treatment with dantrolene and bromocriptine.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Catatonia; Electroconvulsive Therapy; Female; Humans; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine; Psychomotor Agitation

Topics: Adolescent; Adult; Aged; Antipsychotic Agents; Benzodiazepines; Humans; Middle Aged; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine; Risperidone; Selective Serotonin Reuptake Inhibitors

Topics: Aged; Aged, 80 and over; Antipsychotic Agents; Benzodiazepines; Fever; Humans; Male; Mental Disorders; Muscle Rigidity; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine

To date only five reports of neuroleptic malignant syndrome (NMS) related to olanzapine exist. The first case report was published in November 1998.. We report the case of a 78-year-old woman suffering from chronic schizophrenia who developed a NMS while being treated with olanzapine and levomepromazine. Before this her medication had been unchanged for more than 2 years.. When treated with olanzapine and levomepromazine, the patient had a fulminant NMS which was complicated with pneumonia. When the neuroleptic drug treatment was discontinued, the patient recovered. However, when this combination was restarted later due to severe agitation and hallucinations, the symptoms of NMS reappeared.. This case report shows that the neuroleptic malignant syndrome can occur during olanzapine treatment as well as during treatment with conventional neuroleptics. This syndrome may develop even after a long and stable neuroleptic treatment.

Topics: Aged; Antipsychotic Agents; Benzodiazepines; Chronic Disease; Female; Humans; Methotrimeprazine; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine; Schizophrenia

Topics: Aged; Antipsychotic Agents; Benzodiazepines; Humans; Male; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine

We present the case of a 42-year-old male with a history of schizophrenia who developed signs and symptoms consistent with Neuroleptic Malignant Syndrome (NMS) after 3 weeks of treatment with Olanzapine. The patient presented with hyperpyrexia, tremors, labile blood pressure, and mental status changes that had progressed over the preceding 24 h. Laboratory data revealed a metabolic acidosis and an escalating creatinine phosphokinase. Olanzapine is a relatively new atypical anti-psychotic agent first introduced in November of 1996 under the trade name of zyprexa. Olanzapine differs from typical anti-psychotic agents in that it has a lower affinity for dopaminergic receptors and binds antagonistically to serotonin receptors in the nigrostriatal pathway. These unique properties result in relatively fewer extra-pyramidal symptoms when compared to traditional anti-psychotics. Because of olanzapine's favorable side-effect profile, it has quickly gained popularity in the psychiatric community. Although NMS is a recognized complication of anti-psychotic use, there has been only one case of olanzapine induced NMS reported in the literature. The POISON-INDEX system, used by toxicologists throughout the United States, does not list NMS as a potential reaction to olanzapine. The pharmacists at our institution were also unaware that NMS was a possible complication of olanzapine. We present this case to make clinicians aware of the potential for Olanzapine induced NMS.

Topics: Adult; Anti-Bacterial Agents; Antipsychotic Agents; Benzodiazepines; Bromocriptine; Combined Modality Therapy; Cryotherapy; Dantrolene; Dopamine Agonists; Emergency Treatment; Hemiplegia; Humans; Intubation, Intratracheal; Male; Muscle Relaxants, Central; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine; Schizophrenia; Selective Serotonin Reuptake Inhibitors

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Female; Humans; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine; Schizophrenia

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Humans; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine; Schizophrenia, Paranoid

A case of neuroleptic malignant syndrome (NMS) in a 23 year old male patient is reported. The symptoms were hyperthermia, muscle rigidity, change in mental status, sinus tachycardia, creatinine phosphokinase elevation and myoglobinuria. The patient suffered from severe muscle pain and compromised respiratory function. Treatment was cessation of neuroleptic medication and institution of intensive medical care focusing on symptomatic treatment. One week after admission clinical status and laboratory findings were normalized and the patient was readmitted to a psychiatric hospital. The neuroleptic medication of the reported patient had been olanzapine during seven months at a dose of 25 mg daily. The day before onset of NMS the pharmacological treatment was supplemented by 100 mg of clozapine. The cause of onset of NMS in this case is discussed. Clozapine, an atypical neuroleptic, is known to have reduced potential to cause NMS and in such cases without extrapyramidal symptoms. Olanzapine, however, has not yet been reported to cause NMS. Alternatively the cause of onset of NMS in this patient could be explained by the combination treatment and possible synergistic effect of the two antipsychotic drugs. Further research in this field is needed.

Topics: Adult; Antipsychotic Agents; Autistic Disorder; Benzodiazepines; Clozapine; Drug Synergism; Humans; Male; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Humans; Male; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine; Schizophrenia

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Comorbidity; Humans; Intellectual Disability; Male; Mental Disorders; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine

Topics: Adverse Drug Reaction Reporting Systems; Antipsychotic Agents; Benzodiazepines; Humans; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine

Topics: Antipsychotic Agents; Benzodiazepines; Humans; Male; Middle Aged; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine

Topics: Antipsychotic Agents; Benzodiazepines; Female; Humans; Middle Aged; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine; Schizophrenia, Paranoid

Topics: Aged; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Chlorprothixene; Clopenthixol; Female; Humans; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine; Psychotic Disorders; Recurrence

Topics: Antipsychotic Agents; Benzodiazepines; Dibenzothiazepines; Humans; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine; Quetiapine Fumarate

To report a case of neuroleptic malignant syndrome (NMS) associated with the use of olanzapine.. A 67-year-old white man with bipolar disorder developed nausea and vomiting. After 12 days, he became confused, delirious, and manic. His only medications were olanzapine 10 mg/d and divalproex sodium 500 mg bid. He was admitted to a hospital and treated for dehydration and mania. Olanzapine was given on 6 of the first 7 hospital days. On hospital day 6, typical NMS developed with the body temperature increasing to 39.9 degrees C, obtundation, rigidity, tremor, diaphoresis, fluctuating pupillary diameter, labile tachycardia and hypertension, hypernatremia, and elevated serum creatine kinase. Olanzapine was stopped after hospital day 7, and the syndrome resolved by hospital day 12.. The patient had all of the major manifestations of NMS. There was no other likely explanation for his illness and he received no other drug likely to be associated with the syndrome. This is the first case reported in which NMS was associated with olanzapine.

Topics: Aged; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Humans; Male; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Female; Humans; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine; Schizophrenia, Paranoid

The neuroleptic malignant syndrome (NMS) consists in an idiosyncratic reaction to neuroleptic drugs, probably related to a blockage of dopamine receptors in basal ganglia. Research criteria for diagnosing NMS from DSM-IV require severe rigidity and fever accompanied by 2 of 10 minor features including diaphoresis, dysphagia, tremor, incontinence, altered mentation, mutism, tachycardia, elevated or labile blood pressure, leukocytosis and elevation of creatine phosphokinase. From a clinical point of view, the NMS may range a large spectrum of presentations. Haloperidol is the most frequent drug associated with this syndrome. We report the case of a 30 year-old man who developed NMS at two different occasions, the first related to haloperidol and chlorpromazine and the second related to olanzapine, to our knowledge without previous mention in the indexed literature.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Chlorpromazine; Haloperidol; Humans; Male; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine; Recurrence

The aim of the present paper is to report a case of Neuroleptic Malignant Syndrome (NMS) occurring 2 days after olanzapine was added to the treatment regimen of an elderly patient with Schizoaffective Disorder. The patient had a previous history of NMS associated with risperidone.. Two days after commencement of olanzapine, the patient presented in a stuporous state with dysarthria and increased muscle tone with cogwheeling. His level of consciousness fluctuated over the following 24 h with worsening rigidity, the onset of a mild fever, tachycardia and elevated blood pressure. Biochemical screening revealed markedly elevated creatine kinase.. Olanzapine was ceased and intravenous fluid replacement commenced. Hourly physical observations were instigated, as was regular serum monitoring of creatine kinase level.. Over the subsequent 48 h, there was gradual clinical improvement with resolution of dysarthria, ataxia, rigidity and fever. The patient was returned to the psychiatric ward 3 days after his admission to the medical ward.. Olanzapine therapy can be associated with NMS. To our knowledge, there are no previous reports of this in the literature.

Topics: Aged; Antipsychotic Agents; Benzodiazepines; Diagnosis, Differential; Humans; Male; Neuroleptic Malignant Syndrome; Olanzapine; Pirenzepine; Psychotic Disorders