Antipsychotic dose escalation as a trigger for Neuroleptic Malignant Syndrome (NMS): literature review and case series report
<p>Abstract</p> <p>Background</p> <p>“Neuroleptic malignant syndrome” (NMS) is a potentially fatal idiosyncratic reaction to any medication which affects the central dopaminergic system. Between 0.5% and 1% of patients exposed to antipsychotics develop the condition. Mo...
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| Format: | Article |
| Language: | English |
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BMC
2012-11-01
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| Series: | BMC Psychiatry |
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| Online Access: | http://www.biomedcentral.com/1471-244X/12/214 |
| _version_ | 1831598287448178688 |
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| author | Langan Julie Martin Daniel Shajahan Polash Smith Daniel J |
| author_facet | Langan Julie Martin Daniel Shajahan Polash Smith Daniel J |
| author_sort | Langan Julie |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>“Neuroleptic malignant syndrome” (NMS) is a potentially fatal idiosyncratic reaction to any medication which affects the central dopaminergic system. Between 0.5% and 1% of patients exposed to antipsychotics develop the condition. Mortality rates may be as high as 55% and many risk factors have been reported. Although rapid escalation of antipsychotic dose is thought to be an important risk factor, to date it has not been the focus of a published case series or scientifically defined.</p> <p>Description</p> <p>We aimed to identify cases of NMS and review risk factors for its development with a particular focus on rapid dose escalation in the 30 days prior to onset. A review of the literature on rapid dose escalation was undertaken and a pragmatic definition of “rapid dose escalation” was made. NMS cases were defined using DSM-IV criteria and systematically identified within a secondary care mental health service. A ratio of titration rate was calculated for each NMS patient and “rapid escalators” and “non rapid escalators” were compared. 13 cases of NMS were identified. A progressive mean dose increase 15 days prior to the confirmed episode of NMS was observed (241.7 mg/day during days 1–15 to 346.9 mg/day during days 16–30) and the mean ratio of dose escalation for NMS patients was 1.4. Rapid dose escalation was seen in 5/13 cases and non rapid escalators had markedly higher daily cumulative antipsychotic dose compared to rapid escalators.</p> <p>Conclusions</p> <p>Rapid dose escalation occurred in less than half of this case series (n = 5, 38.5%), although there is currently no consensus on the precise definition of rapid dose escalation. Cumulative antipsychotic dose – alongside other known risk factors - may also be important in the development of NMS.</p> |
| first_indexed | 2024-12-18T14:00:17Z |
| format | Article |
| id | doaj.art-01597f1c282744be9a00b95142814a3a |
| institution | Directory Open Access Journal |
| issn | 1471-244X |
| language | English |
| last_indexed | 2024-12-18T14:00:17Z |
| publishDate | 2012-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Psychiatry |
| spelling | doaj.art-01597f1c282744be9a00b95142814a3a2022-12-21T21:05:21ZengBMCBMC Psychiatry1471-244X2012-11-0112121410.1186/1471-244X-12-214Antipsychotic dose escalation as a trigger for Neuroleptic Malignant Syndrome (NMS): literature review and case series reportLangan JulieMartin DanielShajahan PolashSmith Daniel J<p>Abstract</p> <p>Background</p> <p>“Neuroleptic malignant syndrome” (NMS) is a potentially fatal idiosyncratic reaction to any medication which affects the central dopaminergic system. Between 0.5% and 1% of patients exposed to antipsychotics develop the condition. Mortality rates may be as high as 55% and many risk factors have been reported. Although rapid escalation of antipsychotic dose is thought to be an important risk factor, to date it has not been the focus of a published case series or scientifically defined.</p> <p>Description</p> <p>We aimed to identify cases of NMS and review risk factors for its development with a particular focus on rapid dose escalation in the 30 days prior to onset. A review of the literature on rapid dose escalation was undertaken and a pragmatic definition of “rapid dose escalation” was made. NMS cases were defined using DSM-IV criteria and systematically identified within a secondary care mental health service. A ratio of titration rate was calculated for each NMS patient and “rapid escalators” and “non rapid escalators” were compared. 13 cases of NMS were identified. A progressive mean dose increase 15 days prior to the confirmed episode of NMS was observed (241.7 mg/day during days 1–15 to 346.9 mg/day during days 16–30) and the mean ratio of dose escalation for NMS patients was 1.4. Rapid dose escalation was seen in 5/13 cases and non rapid escalators had markedly higher daily cumulative antipsychotic dose compared to rapid escalators.</p> <p>Conclusions</p> <p>Rapid dose escalation occurred in less than half of this case series (n = 5, 38.5%), although there is currently no consensus on the precise definition of rapid dose escalation. Cumulative antipsychotic dose – alongside other known risk factors - may also be important in the development of NMS.</p>http://www.biomedcentral.com/1471-244X/12/214Neuroleptic malignant syndromeNMSRapid dose escalationRapid dose titrationAntipsychotics |
| spellingShingle | Langan Julie Martin Daniel Shajahan Polash Smith Daniel J Antipsychotic dose escalation as a trigger for Neuroleptic Malignant Syndrome (NMS): literature review and case series report BMC Psychiatry Neuroleptic malignant syndrome NMS Rapid dose escalation Rapid dose titration Antipsychotics |
| title | Antipsychotic dose escalation as a trigger for Neuroleptic Malignant Syndrome (NMS): literature review and case series report |
| title_full | Antipsychotic dose escalation as a trigger for Neuroleptic Malignant Syndrome (NMS): literature review and case series report |
| title_fullStr | Antipsychotic dose escalation as a trigger for Neuroleptic Malignant Syndrome (NMS): literature review and case series report |
| title_full_unstemmed | Antipsychotic dose escalation as a trigger for Neuroleptic Malignant Syndrome (NMS): literature review and case series report |
| title_short | Antipsychotic dose escalation as a trigger for Neuroleptic Malignant Syndrome (NMS): literature review and case series report |
| title_sort | antipsychotic dose escalation as a trigger for neuroleptic malignant syndrome nms literature review and case series report |
| topic | Neuroleptic malignant syndrome NMS Rapid dose escalation Rapid dose titration Antipsychotics |
| url | http://www.biomedcentral.com/1471-244X/12/214 |
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