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Electronic letters to:

Practice:
Geethan J. Chandran, John R. Mikler, and David L. Keegan
Neuroleptic malignant syndrome: case report and discussion
CMAJ 2003; 169: 439-442 [Abstract] [Full text] [PDF]
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Electronic letters published:

[Read eLetter] Neuroleptic malignant syndrome
Eileen McGinn   (9 November 2004)

Neuroleptic malignant syndrome 9 November 2004
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Eileen McGinn
MPH

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Re: Neuroleptic malignant syndrome

qedeileen{at}aol.com Eileen McGinn

Neuroleptic malignant syndrome: case report and discussion

This article about neuroleptic malignant syndromw (NMS) is very useful as a reminder of emergencies associated with the use of psychotropic drugs. As noted, even drugs originally proposed to have no/low risk of NMS have now been reported to be associated with NMS. An increase or decrease in neuroleptic dose may precipitate the NMS. Polypharmacy with lithium, anticholinergic drugs and some antidepressants increase the risk of NMS.

Patients with bipolar disorder may be at particular risk for NMS: these patients take four drugs on average, and most patients take a variety of antiepileptic drugs, antipsychotic drugs, antidepressants, antianxiety drugs and/or lithium. Patients with bipolar disorder display higher rates of adverse effects to neuroleptic drugs as compared to patients with schizophrenia.

On the other hand, there is no reason to assume that all patients with bipolar disorder require antipsychotic drugs: lithium and some antiepileptic drugs (valproate and lamotrigine) may be preferable for bipolar patients who develop NMS. Since atypical antipsychotic drugs are associated with all aspects of metabolic syndrome, and since the recent report of the induction of depressive episodes by olanzapine in patients who have the serious variant of rapid cycling bipolar disorder, there may now be good reason to prefer non-neuroleptic drugs for bipolar patients who develop NMS.

Conflict of Interest:

None declared