21. Neuroleptic Malignant Syndrome neuroleptic malignant syndrome. This occurs in 0.51% patients. Untreated mortalityis 20%. Signs and Symptoms In Summary MUSCAT © psychejam 2000. http://www.psychejam.com/neuroleptic_malignant_syndrome.htm

22. Serotonin And Neuroleptic Malignant Syndromes Module IX A Review of Serotonin Syndrome and neuroleptic malignant syndrome.INTRODUCTION. neuroleptic malignant syndrome. Medical Intelligence. http://www.urmc.rochester.edu/urmc/aapcc/serotonin.htm

ELECTRONIC CONTINUING EDUCATION FOR SPECIALISTS IN POISON INFORMATION Module IX - A Review of Serotonin Syndrome and Neuroleptic Malignant Syndrome INTRODUCTION Welcome to Module 9 of the American Association of Poison Control Center’s electronic continuing education program for Specialists in Poison Information. This module will review the pathophysiology, clinical manifestations, monitoring, and management of serotonin syndrome and neuroleptic malignant syndrome. release date - 11/20/98 most recent review date - 11/20/98 LEARNING OBJECTIVES Upon completion of this module, participants will: 1. Understand the pathophysiology for each syndrome. 2. Recognize the clinical manifestations for each syndrome. 3. Understand the monitoring parameters for each syndrome. 4. Understand the management strategies for each syndrome. AUTHOR Peter Ciancaglini, PharmD AUTHOR DECLARATIONS NO DISCLOSURES have been made by the author(s) of this module that could be perceived as a real or apparent conflict of interest in the context of the subject of their presentation(s). REVIEW PANEL Daniel Cobaugh, PharmD

23. Discussion For Question 8 - Module IX Discussion for Question 8 Module IX Which of the following statementsregarding neuroleptic malignant syndrome (NMS) is correct? http://www.urmc.rochester.edu/urmc/aapcc/serotonin/discussion8.htm

Discussion for Question 8 - Module IX Which of the following statements regarding neuroleptic malignant syndrome (NMS) is correct? A. Neuroleptic malignant syndrome is a rare complication of neuroleptic treatment. B. The condition is characterized by a hypometabolic state. C. This syndrome is only associated with phenothiazine neuroleptic treatment. D. Neuroleptic malignant syndrome has not yet been reported in non-psychotic patients receiving neuroleptics. E. Neuroleptic malignant syndrome is more likely to occur during the chronic phase of psychiatric illness in persons stabilized on a medication regimen. Answer A is correct. Neuroleptic malignant syndrome is a rare, but frequently fatal, complication of neuroleptic treatment. The syndrome is related to acute decreases in dopaminergic activity in the central nervous system (e.g., use of dopamine antagonists). Neuroleptic malignant syndrome is characterized by a hypermetabolic state with hyperthermia, muscle rigidity, and autonomic dysfunction. This syndrome has been associated with phenothiazine as well as non-phenothiazine neuroleptics and has been more commonly associated with high potency agents administered in therapeutic dosages.

24. Neuroleptic Malignant Syndrome neuroleptic malignant syndrome. Idiopathic reaction occurring aftertreatment with neuroleptics such as haloperidol or fluphenazine. http://www.aic.cuhk.edu.hk/web8/neuroleptic malig syn.htm

Neuroleptic malignant syndrome Idiopathic reaction occurring after treatment with neuroleptics such as haloperidol or fluphenazine. May occur at any point in anti-psychotic drug therapy with either high or low potency neuroleptics, although usually occurs within 4 weeks of starting therapy May also follow: multiple changes from one neuroleptic to another discontinuation of anti-Parkinsonian drugs administration or rapid increase in dose of potent domapine antagonists Clinical features hyperthermia and muscle rigidity are always present increased muscle tone may lead to decreased chest wall compliance producing tachypnoeic hypoventilation severe enough to require ventilation motor abnormalities range from akinesia to involuntary movements and fluctuating tremors rigidity and akinesia develop concurrently or shortly before pyrexia impaired consciousness autonomic dysfunction causing sweating, tachycardia and labile blood pressure infrequent findings include: oculogyric crises opisthotonus seizures chorea extensor plantars trismus Clinical course develops insidiously over 1-3 days, usually early in a course of treatment or when the dose of drug is increased

25. Neuroleptic Malignant Syndrome Articles, Support Groups, And Resources neuroleptic malignant syndrome articles, support groups, and resourcesfor patients from Med Help International (www.medhelp.org). http://www.medhelp.org/HealthTopics/Neuroleptic_Malignant_Syndrome.html

[Health Topics A-Z] A B C D ... Z Neuroleptic Malignant Syndrome Medical Glossary: NEUROLEPTIC MALIGNANT SYNDROME [Med Help Home] [Library Search] [Medical Forums] ... [Patient Network] Revised: 6/2/2004

26. NEUROLEPTIC MALIGNANT SYNDROME neuroleptic malignant syndrome This describes the combination of catatonic rigidity,stupor, unstable blood pressure, fever, profuse sweating, sweating, and http://www.medhelp.org/glossary2/new/GLS_3312.HTM

NEUROLEPTIC MALIGNANT SYNDROME - This describes the combination of catatonic rigidity, stupor , unstable blood pressure fever , profuse sweating, sweating, and incontinence as a reaction to antipsychotic agents ( phenothiazines ) in therapeutic doses. Med Help Home Search Ask the Doctor Patient Network The medical glossary has been made possible by a generous donation from:

27. Ask The Expert neuroleptic malignant syndrome. Q. What is neuroleptic malignantsyndrome? I ve read that it is often fatal and can be caused by http://www.mhsource.com/expert/exp1072996j.html

Select One Contact CME? Order? Register? Place an Ad? Print Pages? Ask a Colleague? More... ADD/ADHD Alcoholism Alzheimer's Anorexia Anxiety Bipolar Disorder Borderline Bulimia Children Compulsive Dementia Depression Dissociation Drug Abuse Eating Disorders Fear Forgetfulness Hyperactivity Mania Manic-Dep Mood Disorder Narcissistic Neurology Obsessive OCD Panic Paraphilias Phobia Personality Psychosis PTSD Schizophrenia Seasonal Mood Sexual Issues Social Phobia Suicidal Tic Disorders Violence Neuroleptic Malignant Syndrome Q. What is neuroleptic malignant syndrome? I've read that it is often fatal and can be caused by an interaction between Risperdal and Demerol. My friend was given these medications as well as Xanax, Doxepin and lithium would appreciate more information about this syndrome. A. Neuroleptic Malignant Syndrome (NMS) is a severe and sometimes fatal disorder associated with drugs that interfere with a brain chemical (neurotransmitter) called dopamine. Antipsychotic drugs, often called neuroleptics, are the main cause of NMS, but this syndrome can occur in association with other agents; e.g., lithium, or the sudden discontinuation of agents that increase dopamine. NMS has various ways of appearing, but typical symptoms include high fever; muscle rigidity; confusion; fluctuations in pulse and blood pressure; and various biochemical abnormalities. Risperidone alone certainly can cause NMS. I am not aware of any reports of adverse interactions between risperidone and Demerol [meperidine], but since both drugs may be broken down by the same enzyme system in the liver, some adverse interaction is theoretically possible; you may wish to write to the makers of Risperidone (Janssen Pharmaceutica) to see if they have any reports on file but there is nothing in their 1996 product information that indicates an adverse interaction. Demerol can interact in a very serious way with medications called MAOIs. Also, there is a syndrome that can resemble NMS, called malignant hyperthermia, that may follow use of certain anesthetic agents used during surgery.

28. Ask The Expert neuroleptic malignant syndrome. Q. I am curious about the current medicalmanagement of neuroleptic malignant syndrome. Is Dantrolene http://www.mhsource.com/expert/exp1041299a.html

Select One Contact CME? Order? Register? Place an Ad? Print Pages? Ask a Colleague? More... ADD/ADHD Alcoholism Alzheimer's Anorexia Anxiety Bipolar Disorder Borderline Bulimia Children Compulsive Dementia Depression Dissociation Drug Abuse Eating Disorders Fear Forgetfulness Hyperactivity Mania Manic-Dep Mood Disorder Narcissistic Neurology Obsessive OCD Panic Paraphilias Phobia Personality Psychosis PTSD Schizophrenia Seasonal Mood Sexual Issues Social Phobia Suicidal Tic Disorders Violence Neuroleptic Malignant Syndrome Q. I am curious about the current medical management of neuroleptic malignant syndrome. Is Dantrolene utilized at the same dose for malignant syndrome as it is for malignant syndromes seen with the use of anesthetic agents? A. Neuroleptic malignant syndrome (NMS) remains a source of some debate in the literature, both regarding its parameters and its treatment. Good reviews of the topic are found in Velamoor et al, Canadian Journal of Psychiatry 40:545-550, 1995; and in the textbook

29. Neuroleptic Malignant Syndrome: Still A Risk, But Which Patients May Be In Dange neuroleptic malignant syndrome Still a risk, but which patients may be indanger? Atypical antipsychotics and neuroleptic malignant syndrome. http://www.currentpsychiatry.com/2003_12/1203_nms.asp

Vol. 2, No. 12 / December 2003 Neuroleptic malignant syndrome: Still a risk, but which patients may be in danger? Hyperthermic reactions, though rare, can occur with any antipsychotic. Knowing the risk factors and early warning signs remains important to protecting your patients. Stanley N. Caroff, MD Professor of psychiatry University of Pennsylvania School of Medicine Chief, inpatient psychiatry service Department of Veterans Affairs Medical Center Philadelphia, PA To help you protect patients when prescribing antipsychotics or consulting with other clinicians about these drugs, this article discusses: risk factors and clinical features that warn of NMS onset differential diagnosis of disease states most often confused with NMS management recommendations, including supportive measures and specific interventions such as benzodiazepines, dopamine agonists, dantrolene, and electroconvulsive therapy (ECT).

30. NEUROLEPTIC MALIGNANT SYNDROME As stated in a The neuroleptic malignant syndrome and Related Conditions* Interestand increased awareness in febrile catatonic states associated with http://www.idiom.com/~drjohn/biblio.html

NEUROLOGIC MALIGNANT SYNDROME (NMS) A CHRONOLOGICAL ANNOTATED BIBLIOGRAPHY prepared by John M. Friedberg, MD February 5, 1997 Case reports of NMS and literature reviews were readily available in both psychiatric and neurologic journals from 1956, a few years after the introduction of the first phenothiazine, Chlorpromazine (Thorazine). As this chronology shows, there was a flurry of reports throughout the decade of the 1970's. As stated in a The Neuroleptic Malignant Syndrome and Related Conditions*: "Interest and increased awareness in febrile catatonic states associated with neuroleptic administration was quite evident by the mid 1970's. At this time, NMS had been fairly well reported in France, Japan and England. Several American authors cognizant of the French reports, also began to use the term neuroleptic malignant syndrome to describe similar cases in the United States." (p 5) The French were the first to observe the artificial hibernation produced by the anti-histamine related group of drugs called phenothiazines and the first to apply this observation for human behavioral control. It is not surprising that the very term Neurologic Malignant Syndrome is a translation of the French term "syndrome malin des neuroleptiques." Despite the recent obfuscation (e.g. in the book cited above) of NMS and "Lethal Catatonia of Stauder," the epidemic of NMS which followed the epidemic of neuroleptics in the 1860's was clearly a new and alarming phenomenon.

31. Wordbank On The Mental Health Foundation Website neuroleptic malignant syndrome. Very rare condition caused by antipsychoticdrugs and characterised by high temperature, muscle rigidity, and mutism. http://www.mentalhealth.org.uk/wordbank.cfm?wordid=213&wbletter=N

32. Neuroleptic Malignant Syndrome neuroleptic malignant syndrome. http://www.meritcare.com/hwdb/showTopic.asp?pd_hwid=nord763

33. Neuroleptic Malignant Syndrome neuroleptic malignant syndrome. Rare syndrome associated with use of antipsychoticsMain features Muscular rigidity. Pyrexia. Altered consciousness. http://www.mds.qmw.ac.uk/statgen/dcurtis/lectures/nms1.html

Neuroleptic malignant syndrome Rare syndrome associated with use of antipsychotics Main features: Muscular rigidity Pyrexia Altered consciousness Autonomic instability But clinical picture is variable and exact boundaries of condition are unclear nms2.html

34. Neuroleptic Malignant Syndrome (2) neuroleptic malignant syndrome (2). NMS is due to disturbance of dopaminetransmission Occurs with all antidopaminergic agents (anti http://www.mds.qmw.ac.uk/statgen/dcurtis/lectures/nms2.html

Neuroleptic malignant syndrome (2) NMS is due to disturbance of dopamine transmission Occurs with all anti-dopaminergic agents (anti-emetics as well as anti-psychotics) Can occur with withdrawal of dopaminergic drugs used to treat Parkinson's disease Occurs with atypical antipsychotics, including clozapine, although presentation may be less typical In NMS pyrexia is due to: Muscular contraction occurring as an extrapyramidal side effect Central disturbance of temperature control nms1.html nms3.html

35. MedFriendly.com: Neuroleptic Malignant Syndrome provides an easy to understand definition for the medical term, neuroleptic malignantsyndrome. TM, neuroleptic malignant syndrome MedFriendly.com TM TM http://www.medfriendly.com/neurolepticmalignantsyndrome.html

TM Neuroleptic malignant syndrome MedFriendly.com TM TM A B C D ... What is the origin of the term, neuroleptic malignant syndrome? You may also be interested in the 2003 book, Neuroleptic Malignant Syndrome and Related Conditions , which can be purchased by clicking on the link. WHAT IS IT? Neuroleptic malignant syndrome (often abbreviated NMS) is a very rare, but potentially life-threatening complication of antipsychotic medications characterized by the signs and symptoms listed below. Antipsychotic medications (also known as neuroleptics) are used to treat psychosis. Psychosis is a mental disorder characterize by an impaired ability to understand reality. WHAT ARE COMMON SIGNS OF NEUROLEPTIC MALIGNANT SYNDROME? Two key signs of NMS include rigid muscles (in about 90% of case) and hyperthermia. Hyperthermia is a much higher body temperature than normal. Although different medical centers use different criteria to define NMS, most will agree that at least two of the following 11 signs are also present: 1) Sweating (seen in about 60% of cases) that is sometimes severe, 2) high or unstable blood pressure (seen in about 54% of cases), 3) paleness of the skin, 4) an inability to control

36. IPCS INTOX: Neuroleptic Malignant Syndrome neuroleptic malignant syndrome. DEFINITION A lifethreatening idiosyncraticreaction characterised by muscle rigidity and hyperthermia http://www.intox.org/pagesource/treatment/english/neurolepticmanlignant.htm

NEUROLEPTIC MALIGNANT SYNDROME DEFINITION A life-threatening idiosyncratic reaction characterised by muscle rigidity and hyperthermia, related to acute dopamine depletion, either from the use of neuroleptic drugs or of dopamine antagonists, or the withdrawal of dopamine agonists. TOXIC CAUSES Exposure to therapeutic doses of potent neuroleptic drugs (eg, haloperidol, fluphenazine) or the sudden cessation of dopamine agonists such as amantidine. Reported risk factors include dehydration and the concurrent use of lithium and tricyclic antidepressants. CLINICAL FEATURES Extreme hyperpyrexia, lead-pipe muscular rigidity, autonomic dysfunction (tachycardia, elevated or fluctuating blood pressure), sweating, tachypnoea, respiratory failure, altered mental status (confusion, delirium, stupor and coma), extrapyramidal signs (e.g. cogwheel hypertonia). Acute myoglobinuric renal failure may occur. The condition is fatal in up to 12 % of cases. DIFFERENTIAL DIAGNOSIS Anticholinergic poisoning Catatonia CNS infections CNS mass lesions Ethanol or sedative-hypnotic drug withdrawal Extrapyramidal symptoms with fever Heat-stroke (environmental or exertional) Malignant hyperthermia Metal fume fever Psychiatric disorders Septicaemia Strychnine poisoning Thyroid storm Tetanus Tetany RELEVANT INVESTIGATIONS Laboratory tests are generally non-specific, but may be used to exclude alternative diagnoses.

37. Neuroleptic Malignant Syndrome (Treatment Guide) INTOX Home Page neuroleptic malignant syndrome DEFINITION A lifethreatening idiosyncraticreaction characterized by muscle rigidity and hyperthermia, related http://www.intox.org/databank/documents/treat/treate/trt37_e.htm

NEUROLEPTIC MALIGNANT SYNDROME DEFINITION A life-threatening idiosyncratic reaction characterized by muscle rigidity and hyperthermia, related to acute dopamine depletion, either from the use of neuroleptic drugs or of dopamine antagonists, or the withdrawal of dopamine agonists. TOXIC CAUSES Exposure to therapeutic doses of potent neuroleptic drugs (eg, haloperidol, fluphenazine) or the sudden cessation of dopamine agonists such as amantidine. Reported risk factors include dehydration and the concurrent use of lithium and tricyclic antidepressants. CLINICAL FEATURES Extreme hyperpyrexia, lead-pipe muscular rigidity, autonomic dysfunction (tachycardia, elevated or fluctuating blood pressure), sweating, tachypnoea, respiratory failure, altered mental status (confusion, delirium, stupor and coma), extrapyramidal signs (e.g. cogwheel hypertonia). Acute myoglobinuric renal failure may occur. The condition is fatal in up to 12 % of cases DIFFERENTIAL DIAGNOSIS Anticholinergic poisoning Catatonia CNS infections CNS mass lesions Ethanol or sedative-hypnotic drug withdrawal Extrapyramidal symptoms with fever Heat-stroke (environmental or exertional) Malignant hyperthermia Metal fume fever Psychiatric disorders Septicaemia Strychnine poisoning Thyroid storm Tetanus Tetany RELEVANT INVESTIGATIONS Laboratory tests are generally non-specific, but may be used to exclude alternative diagnoses. Arterial blood gases - metabolic acidosis is usually present. Creatinine phosphokinase activity - commonly elevated; marked elevations may indicate a serious risk of acute renal failure. CT scan of the head may be obtained to rule out CNS lesions. Electrolytes - hyperkalaemia, hyper- or hyponatraemia, hypocalcaemia. Liver function tests are not characteristic, but may be elevated. Lumbar puncture to rule out CNS infection. Renal function - urea, creatinine. Standard fever work-up to rule out infections. Urinalysis - urinary myoglobin or myoglobin casts may be present White blood cell count - leukocytosis may be present, (between 12,000 and 30,000 /mm

38. Neuroleptic Malignant Syndrome Lawsuit Overview - Find Trial Lawyers And Attorne neuroleptic malignant syndrome Overview neuroleptic malignant syndrome - FindTrial Lawyers and Attorneys with Experience in neuroleptic malignant syndrome http://www.injuryboard.com/view.cfm/Topic=621

June 2, 2004 The life expectancy for all Americans at birth is now 77.4 years. Vioxx / Rofecoxib Tractor-Trailer Accidents Serzone / Nefazodone Hydrochloride Tort Reform ... Injuries Neuroleptic Malignant Syndrome If you or a family member has been injured, contact a personal injury attorney today. Just fill out InjuryBoard.com's on-line questionnaire and have a personal injury lawyer review your potential personal injury claim - free of charge. Ask an Attorney Neuroleptic Malignant Syndrome (NMS) is a potentially fatal complex that is associated with the use of nearly all antipsychotic drugs. Symptoms of NMS include, but are not limited to, acute kidney failure , body temperature in excess of 106 degrees (hyperpyrexia), rigid muscles, irregular pulse or blood pressure , rapid heart beat ( tachycardia ), and irregular heartbeat. Would you like to use this material on your law firm web site? What do I do Now? As with many personal injury claims, time is critical.

39. NeurolepticMS neuroleptic malignant syndrome. neuroleptic malignant syndrome isa life threatening side effect of any antipsychotic drug but is http://www.psyweb.com/Diction/nms.html

40. Neuroleptic Malignant Syndrome neuroleptic malignant syndrome Important It is possible that the main title ofthe report neuroleptic malignant syndrome is not the name you expected. http://my.webmd.com/hw/schizophrenia/nord763.asp

var guid_source = ""; var guid_source_id = ""; //unused var encodedurl = ""; WebMD Today Home WebMD News Center Member Services WebMD University My WebMD Find a Physician Medical Info Check Symptoms Medical Library Quizzes, Calculators Clinical Trials ... Women, Men, Lifestyle Who We Are About WebMD Site Map You are in Choose a Topic All Conditions ADD/ADHD Allergies Alzheimer's Arthritis Asthma Back Pain Breast Cancer Cancer Dental Depression Diabetes Eye Health Heart Disease Hepatitis HIV/AIDS Hypertension Men's Conditions Mental Health Migraines/Headaches Multiple Sclerosis Osteoporosis Parkinson's Sexual Conditions Stroke Weight Control Women's Conditions Health Topics Symptoms Medical Tests Medications ... For a Complete Report Neuroleptic Malignant Syndrome Important It is possible that the main title of the report Neuroleptic Malignant Syndrome is not the name you expected. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report. Synonyms None Disorder Subdivisions None General Discussion Neuroleptic Malignant Syndrome is a potentially fatal reaction to any of a group of antipsychotic drugs or major tranquilizers (neuroleptics). These drugs are commonly prescribed for the treatment of schizophrenia and other neurological, mental, or emotional disorders. Phenothiazines are one type of neuroleptic and may occasionally be prescribed as a treatment for nausea and vomiting. Several of the most commonly prescribed neuroleptics include thioridazine, haloperidol, chlorpromazine, fluphenazine and perphenazine.

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