Detailed contribution information
| Contribution title | 3430 - Neuroleptic malignant syndrome with combined antipsychotic treatment: clinical report and literature review |
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| Contribution code | PS01-69 (P) |
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| Form of presentation | Poster |
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| Abstract |
Objectives Illustrate through a clinical case and review of the literature the neuroleptic malignant syndrome (NMS), its potentiating factors and pathophysiological mechanisms underlying its emergence. Methods Clinical description and literature review using Pubmed with researching key words: neuroleptic malignant syndrome, autism spectrum disorder, pipamperone and risperidone. Results The propositus is a twelve years old girl of two healthy non-consanguineous parents. She was followed up since the age of four for language delay, deficit in social interaction, stereotyped motor movements and self-mutilation consistent with the diagnosis of autistic disorder with intellectual impairment. Later, risperidone was given at the dose of 1mg per day to deal with the behavioral disturbances that have become more severe over time. Due to the non-response to this treatment a switch with pipamperone 40 mg was indicated. Two days after the overlapping with the two treatments, the patient developed hyperthermia (41,6°C) that did not respond to antipyretic treatment, hypersudation, asthenia and altered mental status. Medical examination and investigations didn’t identify any infectious cause with negative CRP. NMS was suspected, the antipsychotic treatment was interrupted and oral hydration was recommended with good evolution. CPK, made a week later, was 733 UI/L assuming that the rates were higher before. They were back to normal after one week. One of the proposed physiopathology of NMS is the excessive blockade of the dopaminergic receptors. In this case, the association of two antipsychotics, one atypical having a predominant affinity for the D2 receptor, the other typical antagonizing mainly the D4 receptor, might have potentiated the risk of NMS. Conclusion Although all antipsychotics have potential to cause NMS, better knowledge of pharmacological risk factors can help preventing its occurrence. |