Catatonic signs in neuroleptic malignant syndrome

doi:10.1016/S0010-440X(00)90135-4

Comprehensive Psychiatry

Volume 41, Issue 1, January–February 2000, Pages 73-75

https://doi.org/10.1016/S0010-440X(00)90135-4 Get rights and content

Abstract

The study assessed catatonic signs in neuroleptic malignant syndrome (NMS). Records of inpatients meeting both stringent research criteria and DSM-IV criteria (n = 11) or only DSM-IV criteria (n = 5) for NMS were identified. The records were systematically rated on a 23-item rating scale for the presence of catatonic signs. Scores for NMS severity were related to the number of catatonic signs. Fifteen patients met both research criteria for catatonia and DSM-IV motor criteria for organic catatonia. The severity scores of NMS correlated with the number of catatonic signs (Spearman p = +.71, P < .005). We conclude that multiple catatonic signs are present in NMS and the severity of NMS predicts the number of catatonic signs.

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Cited by (57)

Molecular and immunological origins of catatonia
2024, Schizophrenia Research
Catatonia occurs secondary to both primary psychiatric and neuromedical etiologies. Emerging evidence suggests possible linkages between causes of catatonia and neuroinflammation. These include obvious infectious and inflammatory etiologies, common neuromedical illnesses such as delirium, and psychiatric entities such as depression and autism-spectrum disorders. Symptoms of sickness behavior, thought to be a downstream effect of the cytokine response, are common in many of these etiologies and overlap significantly with symptoms of catatonia. Furthermore, there are syndromes that overlap with catatonia that some would consider variants, including neuroleptic malignant syndrome (NMS) and akinetic mutism, which may also have neuroinflammatory underpinnings. Low serum iron, a common finding in NMS and malignant catatonia, may be caused by the acute phase response. Cellular hits involving either pathogen-associated molecular patterns (PAMP) danger signals or the damage-associated molecular patterns (DAMP) danger signals of severe psychosocial stress may set the stage for a common pathway immunoactivation state that could lower the threshold for a catatonic state in susceptible individuals. Immunoactivation leading to dysfunction in the anterior cingulate cortex (ACC)/mid-cingulate cortex (MCC)/medial prefrontal cortex (mPFC)/paralimbic cortico-striato-thalamo-cortical (CSTC) circuit, involved in motivation and movement, may be particularly important in generating the motor and behavioral symptoms of catatonia.
What clinical analysis of antipsychotic-induced catatonia and neuroleptic malignant syndrome tells us about the links between these two syndromes: A systematic review
2023, Schizophrenia Research
Antipsychotic-induced catatonia (AIC) and neuroleptic malignant syndrome (NMS) are life-threatening adverse reactions to antipsychotic medication. We conducted a systematic review of literature following the PRISMA statement guidelines to obtain a description of these syndromes (population, context of occurrence, antipsychotic agents implicated) and draw conclusions about their links.
We searched Medline and Web of science databases from January 1951 to May 2019 (further restricted from 2000 to 2019) using search terms including “catatonia”, “neuroleptic malignant syndrome” and “antipsychotic agents” for case reports, case series and analytic studies. After screening 4082 records, 410 full-text articles (describing 555 events) were assessed for eligibility. We included events of AIC and/or NMS according to Diagnostic and Statistical Manual (DSM) criteria and extracted data about patients' characteristics, context of occurrence, antipsychotic agent(s) involved and treatment outcomes.
We included 165 events (16 AIC, 129 NMS and 20 AIC + NMS) from 144 case reports and case series. The most reported diagnosis was schizophrenia. Comorbid pre-existing conditions such as central nervous system diseases and acute medical events were common. Most of the events (63.3 %) occurred during antipsychotic monotherapy. Second-generation antipsychotics (SGAs, 63.8 %) were overall more implicated than first-generation antipsychotics (FGAs, 36.2 %).
Our findings highlight that any antipsychotic medication, even SGA monotherapy prescribed at recommended dose, is at risk for these side effects. FGAs and polypharmacy seem to represent risk factors for malignant catatonia in AIC. The clinical overlap observed between AIC and NMS events in our review suggests a clinical continuum between catatonia and NMS.
A case of influenza-associated invasive aspergillosis with cerebral hemorrhage due to infectious vasculopathy
2022, Radiology Case Reports
Citation Excerpt :
It might be likely that not only GM and PCR but β-D-glucan could be candidate of diagnostic test because of its high feasibility and lower cost. The several meta-analyses and study [15] supported that (1→3)-β-d-glucan assay is considered a useful diagnostic tool with knowledge of the limitations of the assay. [20–22]. Few studies have performed direct comparisons of 2 assays for diagnosis of IA in the same patients.
An invasive aspergillosis (IA) primarily occurs among immunocompromised patients. Recently with an influenzae infection prevalently spreading, influenzae-associated invasive aspergillosis (IAIA) has been reported occasionally. By contrast, neuroleptic malignant syndrome (NMS) occurs rarely in psychiatric patients who are treated with Olanzapine. We report a 43 years old male with psychiatric disorder who had developed IAIA followed by NMS and cerebral hemorrhage as the result of aspergillus invasion to cerebral vessels. He had also super-infection of COVID-19, 13 months later to be saved completely after invasive mechanical respiratory supports. From clinical aspects, we would emphasize that it is of importance to find earlier co-occurrence of IAIA patients with cerebral hemorrhage due to secondary infectious vasculopathy of IA.
Neuroleptic malignant syndrome
2016, Acta Colombiana de Cuidado Intensivo
El síndrome neuroléptico maligno se caracteriza por ser una enfermedad que además de ser poco frecuente y potencialmente letal, requiere de un diagnóstico oportuno haciendo diferenciación de otras patologías igualmente poco frecuentes y por ende desconocidas por buena parte del personal médico como la catatonia letal, y la hipertermia maligna, cuyo mecanismo fisiopatológico es completamente diferente pero que de igual manera son devastadoras y potencialmente letales.
En esta revisión se hará especial relevancia en su epidemiología, fisiopatología, diagnóstico diferencial y enfoque terapéutico.
Destacaremos la importancia de mantener una alta sospecha de este cuadro clínico teniendo en cuenta que hay un aumento actual en la formulación de medicamentos neurolépticos, y aparición de enfermedades psiquiátricas en nuestra población. El mantener una alta sospecha de este cuadro, permitirá realizar un diagnóstico precoz e iniciar un tratamiento oportuno y adecuado, logrando así reducir la morbimortalidad asociada.
Neuroleptic malignant syndrome is a disease that, in addition to being rare, is potentially life-threatening. Its early diagnosis by differentiation from other diseases, also rare, and thus unknown by much of the medical personnel, such as lethal catatonia and malignant hyperthermia, where the pathophysiological mechanism is totally different but just as devastating and potentially life-threatening.
In this review, special relevance will be made to its epidemiology, pathophysiology, differential diagnosis, and therapeutic approach.
Emphasis will be placed on the importance of maintaining a high suspicion of this clinical picture, taking into account that there is a current actual increase in the formulation of neuroleptic drugs and emergence of psychiatric illness in our population. Maintaining a high suspicion of this clinical picture will allow early diagnosis and initiate timely and appropriate treatment, and thus reducing the associated mortality and morbidity.
Measuring catatonia: A systematic review of rating scales
2011, Journal of Affective Disorders
Citation Excerpt :
Current rating scales are not designed to detect NMS, and only the BFCRS and the NCRS have included ‘autonomic abnormalities’ as a separate item. The number of catatonic signs has been shown to correlate with the severity of NMS (Koch et al., 2000). A specific rating scale for NMS, containing several catatonia items, has been described (Sachdev, 2005) but not correlated with catatonia scales.
Despite a growing scientific and clinical interest in catatonia, its precise definition remains debated.
The aim of this study was to offer a systematic review of the different rating scales that have been developed to assess catatonia in clinical practice.
A Medline-search was performed, up to December 2010.
Seven catatonia rating scales were retrieved: the Modified Rogers Scale, the Rogers Catatonia Scale, the Bush–Francis Catatonia Rating Scale (BFCRS), and its revision, the Northoff Catatonia Rating Scale (NCRS), the Braunig Catatonia Rating Scale (BCRS), and the Kanner Scale.
Several catatonia rating scales are proposed to detect the catatonic syndrome and to evaluate treatment response. BFCRS, NCRS and BCRS are reliable for use in variable populations in which catatonia is prevalent. The BFCRS is preferred for routine use, because of its validity and reliability, and its ease of administration.
Catatonia in adult anti-NMDAR encephalitis: an observational cohort study
2023, BMC Psychiatry

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Catatonic signs in neuroleptic malignant syndrome

Abstract

Biol Psychiatry

Biol Psychiatry

Lancet

Biol Psychiatry

The non dichotomy between lethal catatonia and neuroleptic malignant syndrome

J Clin Psychopharmacol

Increase of serum creatinine phosphokinase in catatonia: an investigation in 32 acute catatonic patients

Psychol Med

Serum iron in catatonia

Biol Psychiatry

Diazepam-responsive neuroleptic malignant syndrome: a diagnostic subtype?

Am J Psychiatry

Chlorpromazine-induced neuroleptic syndrome and its response to lorazepam

Biol Psychiatry