Neuroleptic malignant syndrome is a rare and life-threatening disorder caused by the use of psychotropic drugs, especially neuroleptics belonging to the groups of phenothiazines, thioxanthenes and butyrophenones. The use of drugs such as amphetamine, Amoxalin, Fluoxetine, Desipramine, Phenelzine, cocaine or Metoclopramide can provoke NMS.
Reasons
Probability factors for the formation of neuroleptic syndrome can be:
- taking long-acting drugs;
- use of highly potent funds;
- use of anti-NSD drugs along with anticholinergic drugs;
- antidepressants;
- air temperature;
- electroconvulsive treatment and high humidity.
Exacerbation of the disease can be caused by reasons directly related to the physiological well-being of the patient. These include:
- dehydration;
- psychomotor irritation;
- alcoholism;
- mental retardation;
- postpartum;
- intercurrent infection;
- iron deficiency;
- physical exhaustion;
- traumatic brain injury;
- thyroid dysfunction.
The state of incoherence, old age, emotional nervousness, male sex - all this also exacerbates neuroleptic malignant syndrome. The symptoms of IDD can range from mild to noticeable.
Easy variety of development
Malignant neuroleptic syndrome is characterized by the following indications: the temperature rises to subfebrile numbers, small somatovegetative failures occur (BP pulse within 150/90-110/70 mm Hg, tachycardia - up to 100 beats per minute), and also deviations in laboratory data (an increase in ESR up to 18-30 mm / h, a low number of lymphocytes - from 15 to 19%). There are no disorders of homeostasis and hemodynamic growth. The psychopathological state is formed by oneiroid-catatonic or affective-delusional attacks.
Medium degree
The following signs indicate that a person is ill with moderate neuroleptic malignant syndrome:
- manifested somatovegetative disorders (asthma with tachycardia up to 120 beats per minute);
- increased body temperature (up to 38-39 degrees);
- tangible changesin laboratory data (ESR increases to 35-50 mm / h, and leukocytosis - up to 10J109 / l, the number of leukocytes decreases to 10-15%);
- the level of creatine phosphokinase and transaminase in the blood increases;
- moderately detected hypokalemia and hypovolemia are noted.
The psychopathological type is characterized by violations of feeling of amental-like and oneiric degree. Catatonic symptoms are manifested by immobility with negativism, an increase (in the evenings) of cases of irritation with nervousness, motor and speech stereotypes.
Complicated process
Against the background of hyperthermia, a malignant neuroleptic syndrome can also occur. The symptoms are already more severe, namely:
- somatovegetative failures are increasing (shortness of breath up to 30 breaths in 1 minute, tachycardia reaches 120-140 beats per minute);
- fluid and electrolyte disorders increase;
- hemodynamic disturbances increase.
The greatest change in traits is found in laboratory numbers. ESR increases to 40-70 mm/h, leukocytes - up to 12J109/l, the number of lymphocytes decreases to 3-10%, the degree of creatine phosphokinase, aspartic and alanine transaminase in the blood increases significantly. The obscuration of the mind can reach coma, soporous and amental stages. Numbness, negativism, chaotic irritation, lethargy with a decrease in muscle tone, and in especially serious cases, absolute immobility with areflexia - all this is a malignant neuroleptic syndrome.
Treatment
Timely identification of the disease is the main point. The fact that a person is sick with neuroleptic malignant syndrome can be indicated by muscle tension, tachycardia, fever, hypertension, increased sweating found after taking antipsychotics, dysphagia.
The first thing a doctor should do is stop antipsychotics and other neurotoxic drugs. Supportive procedures will also be required to bring down the temperature and make up for the lack of fluids. Electrolyte imbalance must be excluded. Be sure to carefully monitor the respiratory activity, which can be repeatedly disturbed by the formation of severe muscle rigidity and helplessness to cough up bronchial secretions.
Need to closely monitor the function of the kidneys. However, there is no evidence that the osmotic compartment accelerates post NMS recovery, just that it may help support renal function. It is often necessary to perform therapy in an enhanced treatment setting.
Drug Therapy
It is desirable to treat neuroleptic malignant syndrome with medications in difficult cases. For this, muscle relaxants (Dantrolene) or dopamine agonists (Amantadine and Bromocriptine) are used. Mortality decreases with the use of both types of drugs. Doses are freely changed, however, for Bromocriptine, the sources describe doses in sizes from 2, 5 and up to 5 mg 3 times a day.day orally.
Dopamine agonists, especially in large doses, can provoke psychosis or vomiting, and this can significantly aggravate the well-being of a patient with neuroleptic malignant syndrome. A direct acting muscle relaxant is used at doses as low as 10 mg/kg. The purpose of its use is to reduce muscle rigidity, as well as skeletal muscle metabolism, the increase of which is partially responsible for hyperthermia. "Dantrolene" is hepatotoxic, can provoke hepatitis and even death as a result of liver failure. And then there will be no point in further treatment of neuroleptic malignant syndrome.
NMS is also eliminated by a combination of dopamine agonists and Dantrolene. Anticholinergic drugs, widely used to treat neuroleptic pseudoparkinsonism, do not provide significant results, moreover, they can further disrupt thermoregulation.
There is recent information on the effectiveness of "Carbamazepine", which in many patients showed a rapid weakening of the indications of NMS. However, there are no reliable data on the effectiveness of the use of benzodiazepines for the treatment of this syndrome. However, when the condition improves, these drugs may be useful in reducing irritation in patients with neuroleptic malignant syndrome.
Hyperthermia
The disease can be detected approximately once in 100,000 anesthesias using depolarizing muscle relaxants(Myorelaxin, Ditilin and Listenone), as well as inhalation anesthetics from among halogen-substituted hydrocarbons (Methoxyflurane, Fluorogan and Halothane). Hyperthermia appears in patients with high susceptibility to these drugs, which is associated with failures of calcium metabolism in muscle masses. The result is generalized muscle twitching, and sometimes muscle disease, as a result of which a huge amount of heat is formed, the body temperature instantly reaches 42 degrees. Neuroleptic Malignant Syndrome causes death in 20-30% of cases.
Ambulance
When detecting fast-growing hyperthermia, stop taking the above medications. Of the anesthetic drugs that do not provoke the disease, barbiturates, Pancuronium, Tubocurarine and nitrous oxide can be distinguished. Just they should be used when it is necessary to extend anesthesia care.
Due to the likelihood of developing ventricular arrhythmia, the prophylactic use of "Phenobarbital" and "Procainamide" in therapeutic dosages is prescribed. It is also necessary to prepare cooling procedures by placing containers of cold water or ice over large blood vessels. It is required to immediately normalize the inhalation of air, inject sodium bicarbonate intravenously (400 ml of a 3% solution). In dangerous cases, the implementation of resuscitation measures is recommended. Hospitalization is the first thing to do if neuroleptic malignant syndrome is diagnosed.
Forecast
Having a history of NMS always increases the likelihood of a secondary course of such a condition and complicates the course of the prevailing malaise. Moreover, the disorders that arise in this syndrome almost never bypass the brain structure without traces, creating certain neurological disorders. So what is neuroleptic malignant syndrome? This is a disease that significantly impairs a person's life, and can even lead to death.
