Rapid symptom control in neuroleptic malignant syndrome with electroconvulsive therapy

Detalhes bibliográficos
Autor(a) principal: Katzell, Lauren
Data de Publicação: 2023
Outros Autores: Beydler, Emily, dos Santos, Amílcar Silva, Vijayvargiya, Richa, Carr, Brent R.
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://hdl.handle.net/10362/151943
Resumo: Publisher Copyright: Copyright © 2023 Katzell, Beydler, dos Santos, Vijayvargiya and Carr.
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spelling Rapid symptom control in neuroleptic malignant syndrome with electroconvulsive therapyA case reportamantadinecase reportscatatoniaelectroconvulsive therapyneuroleptic malignant syndromeschizoaffective disorderPsychiatry and Mental healthSDG 3 - Good Health and Well-beingPublisher Copyright: Copyright © 2023 Katzell, Beydler, dos Santos, Vijayvargiya and Carr.Introduction: Neuroleptic malignant syndrome (NMS), thought to arise through dopamine antagonism, is life-threatening. While prompt diagnosis of NMS is critical, it may be obscured by other diagnoses, such as malignant catatonia, with overlapping, life-threatening symptoms. Initiation of dopamine-blocking agents such as antipsychotics and abrupt cessation of dopaminergic medications such as amantadine can precipitate NMS. Once NMS is suspected, deft medical management should ensue. Multiple case reports detail electroconvulsive therapy’s (ECT’s) effectiveness in the treatment of NMS. While this relationship is well-documented, there is less literature regarding comparative efficacy of ECT in the acute treatment of NMS-like states precipitated by withdrawal of dopamine agonists, such as amantadine. Case: We present a 52-year-old female with schizoaffective disorder bipolar type, with a history of a lorazepam-resistant catatonic episode the prior year that had responded to amantadine. She presented febrile with altered mental status, lead pipe rigidity, mutism, grasp reflex, stereotypy, autonomic instability, and a Bush-Francis Catatonia Rating Scale (BFCRS) of 24, suggesting malignant catatonia versus NMS. There was concern over a potentially abrupt cessation of her amantadine of which she had been prescribed for the past year. Interventions: Organic etiologies were ruled out, and a presumptive diagnosis of NMS was made with central dopaminergic depletion from abrupt dopamine agonist (amantadine) withdrawal as the suspected underlying etiology. After intravenous lorazepam and reinduction of amantadine failed to alleviate her symptoms, urgent ECT was initiated. Our patient received an index series of ECT of seven treatments. After ECT #1 she was no longer obtunded, after treatment #2 her symptoms of mutism, rigidity, stereotypy, and agitation showed improvement, and by ECT #3, the NMS had rapidly dissipated as evidenced by stable vital signs, lack of rigidity, and coherent conversation. Conclusion: Brisk identification of potentially life-threatening NMS and NMS-like states, including malignant catatonia, warrants a trial of ECT. ECT’s theoretical mechanisms of action coincide with the theoretical pathophysiology of the conditions. It is a viable and safe treatment option for reducing mortality. With prompt initiation of ECT, we obtained rapid control of a condition with a potentially high mortality.NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)RUNKatzell, LaurenBeydler, Emilydos Santos, Amílcar SilvaVijayvargiya, RichaCarr, Brent R.2023-04-19T22:23:47Z20232023-01-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10362/151943eng1664-0640PURE: 58481972https://doi.org/10.3389/fpsyt.2023.1143407info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2024-03-11T05:34:18Zoai:run.unl.pt:10362/151943Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T03:54:44.090249Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Rapid symptom control in neuroleptic malignant syndrome with electroconvulsive therapy
A case report
title Rapid symptom control in neuroleptic malignant syndrome with electroconvulsive therapy
spellingShingle Rapid symptom control in neuroleptic malignant syndrome with electroconvulsive therapy
Katzell, Lauren
amantadine
case reports
catatonia
electroconvulsive therapy
neuroleptic malignant syndrome
schizoaffective disorder
Psychiatry and Mental health
SDG 3 - Good Health and Well-being
title_short Rapid symptom control in neuroleptic malignant syndrome with electroconvulsive therapy
title_full Rapid symptom control in neuroleptic malignant syndrome with electroconvulsive therapy
title_fullStr Rapid symptom control in neuroleptic malignant syndrome with electroconvulsive therapy
title_full_unstemmed Rapid symptom control in neuroleptic malignant syndrome with electroconvulsive therapy
title_sort Rapid symptom control in neuroleptic malignant syndrome with electroconvulsive therapy
author Katzell, Lauren
author_facet Katzell, Lauren
Beydler, Emily
dos Santos, Amílcar Silva
Vijayvargiya, Richa
Carr, Brent R.
author_role author
author2 Beydler, Emily
dos Santos, Amílcar Silva
Vijayvargiya, Richa
Carr, Brent R.
author2_role author
author
author
author
dc.contributor.none.fl_str_mv NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
RUN
dc.contributor.author.fl_str_mv Katzell, Lauren
Beydler, Emily
dos Santos, Amílcar Silva
Vijayvargiya, Richa
Carr, Brent R.
dc.subject.por.fl_str_mv amantadine
case reports
catatonia
electroconvulsive therapy
neuroleptic malignant syndrome
schizoaffective disorder
Psychiatry and Mental health
SDG 3 - Good Health and Well-being
topic amantadine
case reports
catatonia
electroconvulsive therapy
neuroleptic malignant syndrome
schizoaffective disorder
Psychiatry and Mental health
SDG 3 - Good Health and Well-being
description Publisher Copyright: Copyright © 2023 Katzell, Beydler, dos Santos, Vijayvargiya and Carr.
publishDate 2023
dc.date.none.fl_str_mv 2023-04-19T22:23:47Z
2023
2023-01-01T00:00:00Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://hdl.handle.net/10362/151943
url http://hdl.handle.net/10362/151943
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv 1664-0640
PURE: 58481972
https://doi.org/10.3389/fpsyt.2023.1143407
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.source.none.fl_str_mv reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron:RCAAP
instname_str Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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reponame_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
collection Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
repository.name.fl_str_mv Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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