What is Neuroleptic Malignant Syndrome?

Malignant syndrome was first proposed by French doctor Delay in 1968, and it is considered that the malignant syndrome is the most serious side effect caused by antipsychotic drugs, and it is rare in clinical practice. Antipsychotics are the most common drugs that cause NMS. Others include lithium salts, carbamazepine, and antidepressants. Almost all of the antipsychotic drugs can cause NMS, especially high-efficiency low-dose antipsychotic drugs, of which haloperidol is the majority. But new antipsychotic drugs have also been reported. It is generally believed that oral, intramuscular, and intravenous administration can cause NMS. But intramuscular and intravenous injections are more likely to occur. NMS often occurs during the change of the type or dosage of antipsychotic drugs and when they are combined (such as lithium salt combined with haloperidol). Excited, antifeedant, poor nutrition, and patients with previous organic diseases are more likely to occur when using antipsychotics and antidepressants. There is no difference between men and women, and it can occur at all ages.

Malignant syndrome

Malignant syndrome was first proposed by French doctor Delay in 1968, and it is considered that the malignant syndrome is the most serious side effect caused by antipsychotic drugs, and it is rare in clinical practice. Antipsychotics are the most common drugs that cause NMS. Others include lithium salts, carbamazepine, and antidepressants. Almost all of the antipsychotic drugs can cause NMS, especially high-efficiency low-dose antipsychotic drugs, of which haloperidol is the majority. But new antipsychotic drugs have also been reported. It is generally believed that oral, intramuscular, and intravenous administration can cause NMS. But intramuscular and intravenous injections are more likely to occur. NMS often occurs during the change of the type or dosage of antipsychotic drugs and when they are combined (such as lithium salt combined with haloperidol). Excited, antifeedant, poor nutrition, and patients with previous organic diseases are more likely to occur when using antipsychotics and antidepressants. There is no difference between men and women, and it can occur at all ages.

The pathological mechanism of malignant syndrome is still not very clear. The main points are: Hypomuscular Disorder Hypothesis, Dopamine Hypothesis Hypothesis, Dopamine P5-Hydroxytryptamine (DAP5-IIT) Hypothesis Hypothesis, GABA Hypothesis, Rhabdomyolysis.

There is no uniform standard for the diagnosis of malignant syndrome. Many people have proposed clinical diagnostic criteria for malignant syndrome. For example: Levenson (1985) proposes 3 main symptoms of NMS (high fever, muscle rigidity, increased CPK) or high fever, muscle rigidity plus any 4 of the following 6 symptoms: increased heart rate, abnormal blood pressure, shortness of breath, consciousness Change, sweating, WBC rising. But this standard has been criticized by posterity. The reason is that according to this standard, malignant syndrome can still be diagnosed without increased muscle tone, which is difficult to distinguish from heat stroke fever and serotonin syndrome. At present, in clinical work, the following diagnostic criteria are often used: A. Application of antipsychotic drugs within 7 days of onset (within 4 weeks of long-acting antipsychotic drugs); B. High fever, body temperature 38 ; C. Muscle Tonicity; D has 3 or more of the following symptoms: (1) altered consciousness; (2) tachycardia; (3) increased or decreased blood pressure; (4) shortness of breath or hypoxia; (5) Increased CPK or myoglobinuria; (6) Increased WBC; (7) Metabolic acidosis. E The above symptoms are not caused by systemic or neurological diseases.

In the treatment of malignant syndrome, timely discontinuation of the original drug, early application of nifediphene and bromocriptine, proper and timely infusion treatment, and prevention of complications are the four keys to successful treatment of this disease and reduction of mortality. So far, some pharmacological and non-drug treatment methods have been used for comprehensive malignant treatment and have achieved certain effects. Among them, nifediphene and bromocriptine are considered to be effective drugs for NMS. Non-drug treatments such as electrical shock therapy and blood purification can also be used for the treatment of NMS.