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An Analysis of 17 Catatonic Patients Diagnosed With Neuroleptic Malignant Syndrome

Published online by Cambridge University Press:  07 November 2014

Denise A. C. White  and
Ashley H. Robins
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Abstract

This study was conducted to show that catatonia is a predisposing factor for neuroleptic malignant syndrome (NMS) and to review the nosological relationship between catatonia and NMS. Seventeen consecutive cases of NMS were analyzed prospectively with reference to clinical and investigative findings before and after exposure to a neuroleptic. The series comprised eight males and nine females, ranging in age from 18 years to 65 years. Prior to neuroleptic exposure, all patients exhibited features compatible with criteria for catatonia (mutism/excitement) according to the Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised, (DSM-III-R). Following neuroleptic administration (single dose in nine cases), patients deteriorated into a febrile, rigid, and obtunded state accompanied by autonomic dysfunction and raised creatine phosphokinase levels. These features were consistent with a diagnosis of NMS. Neuroleptics were discontinued and supportive medical treatment instituted. Benzodiazepines were beneficial in eight cases in relieving stupor, but bromocriptine and dantrolene were generally ineffective. In all patients diagnosed with NMS in the authors' series, catatonia was an invariable prodromal state. It appears that the administration of a neuroleptic intensified the preexisting catatonic state and precipitated a malignant variant of the disorder, which is currently recognized as NMS. The authors, therefore, challenge the separate nosological status of NMS and catatonia and suggest that these syndromes are part of a unitary pathophysiological disorder.

Type
Feature Articles
Information
CNS Spectrums , Volume 5 , Issue 7: Mechanisms and Presentations of Catatonia , July 2000 , pp. 58 - 65
Copyright
Copyright © Cambridge University Press 2000

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References

REFERENCES

1.Castillo, E, Rubin, RT, Holsboer-Trachsler, E. Clinical differentiation between lethal catatonia and neuroleptic malignant syndrome. Am J Psychiatry. 1989;146:324–328.Google ScholarPubMed
2.Fleischhacker, WW, Unterweger, B, Kane, JM, et al.The neuroleptic malignant syndrome and its differentiation from lethal catatonia. Acta Psychiatr Scand. 1990;81:3–5.CrossRefGoogle ScholarPubMed
3.Mann, SC, Caroff, SN, Bleier, HR, et al.Lethal catatonia. Am J Psychiatry. 1986;143:1374–1381.Google ScholarPubMed
4.Weinberger, DR, Kelley, MJ. Catatonia and malignant syndrome: a possible complication of neuroleptic administration. J Nerv Ment Dis. 1977;165:263–268.CrossRefGoogle ScholarPubMed
5.Kellam, AMP. The neuroleptic malignant syndrome, so called. Br J Psychiatry. 1987;150:752–759.CrossRefGoogle Scholar
6.Price, DK, Turnbull, GJ, Gregory, RP, et al.Neuroleptic malignant syndrome in a case of post-partum psychosis. Br J Psychiatry. 1989;155:849–852.CrossRefGoogle Scholar
7.Fink, M. Neuroleptic malignant syndrome and catatonia: one entity or two? Biol Psychiatry. 1996;39:1–4.CrossRefGoogle ScholarPubMed
8.Carroll, BT, Taylor, RE. The nondichotomy between lethal catatonia and neuroleptic malignant syndrome. J Clin Psychopharmacology. 1997;17:235–238.CrossRefGoogle ScholarPubMed
9.Koch, M, Changragiri, S, Rizvi, S, et al.Catatonic signs in neuroleptic malignant syndrome. Compr Psych. 2000;41:73–75.CrossRefGoogle ScholarPubMed
10.Fricchione, GL. Neuroleptic-induced catatonia and its relationship to psychogenic catatonia. Biol Psychiatry. 1985;20:304–313.CrossRefGoogle ScholarPubMed
11.Carroll, BT. The universal field hypothesis of catatonia and NMS. CNS Spectrums. 2000;7:xx–xx.Google Scholar
12.Stauder, KH: Die todliche katatonie. Arch Psychiatr Nervenkr. 1934;102:614–634.CrossRefGoogle Scholar
13.White, DAC, Robins, AH. Catatonia and NMS. Br J Psychiatry. 1991;158:858–859.CrossRefGoogle Scholar
14.Philbrick, KL, Rummans, TA. Malignant catatonia. J Neuropsychiatry Clin Neurosci. 1994;6:1–13.Google ScholarPubMed
15.Delay, J, Pichot, P, Lemperiere, T. Un neuroleptique majeur non phenothiazinique et non reserpinique, l'haloperidol, dans le traitement des psychoses. Ann Med Psychol (Paris). 1960;118:145–152.Google Scholar
16.Caroff, SN. The neuroleptic malignant syndrome. J Clin Psychiatry. 1980;41:79–83.Google ScholarPubMed
17.White, DAC, Robins, AH. Catatonia: harbinger of the neuroleptic malignant syndrome. Br J Psychiatry. 1991;158:419–421.CrossRefGoogle ScholarPubMed
18.White, DAC. Catatonia and the neuroleptic malignant syndrome: a single entity? Br J Psychiatry. 1992;161:558–560.CrossRefGoogle ScholarPubMed
19.Abdelkarim, AO, Khurasani, MH. Lethal catatonia and neuroleptic malignant syndrome: a dopamine receptor shut-down hypothesis. Br J Psychiatry. 1994;165:548–550.Google Scholar
20.Fricchione, GL. Neuroleptic catatonia and its relationship with psychogenic catatonia. Biol Psychiatry. 1985;20:304–313.CrossRefGoogle ScholarPubMed
21.Itoh, H, Ohtsuka, N, Ogita, K, et al.Malignant neuroleptic syndrome: its present status in Japan and clinical problems. Folia Psychiatr Neurol Jpn. 1977;31:559–576.Google ScholarPubMed
22.Keck, PE, Pope, HG, Cohen, BM, et al.Risk factors for neuroleptic malignant syndrome: a case control study. Arch Gen Psychiatry. 1989;46:914–918.CrossRefGoogle ScholarPubMed
23.Rosebush, P, Stewart, T. A prospective analysis of 24 episodes of neuroleptic malignant syndome. Am J Psychiatry. 1989;146:717–725.Google Scholar
24.Addonizio, G, Susman, VL, Roth, SD. Symptoms of neuroleptic malignant syndrome: review and analysis of 115 cases. Biol Psychiatry. 1987;22:1004–1020.CrossRefGoogle ScholarPubMed
25.Abrams, R, Taylor, MA. Catatonia: a prospective clinical study. Arch Gen Psychiatry. 1976;33:579–581.CrossRefGoogle ScholarPubMed
26.Barnes, MP, Saunders, M, Walls, TJ, et al.The syndrome of Karl Ludwig Kahlbaum. J Neurol Neurosurg Psychiatry. 1986;49:991–996.CrossRefGoogle ScholarPubMed
27.Caroff, SN, Rosenberg, H, Fletcher, JE, et al.Malignant hyperthermia susceptibility in neuroleptic malignant syndrome. Anesthesiology. 1987;67:20–25.CrossRefGoogle ScholarPubMed
28.Rosebush, PI, Hildebrand, AM, Furlong, BG, et al.Catatonic syndrome in a general psychiatric population: frequency, clinical presentation and response to lorazepam. J Clin Psychiatry. 1990;51:357–362.Google Scholar
29.Ungvari, GS, Leung, CM, Wong, MK, et al.Benzodiazepines in the treatment of catatonic syndrome. Acta Psychiatr Scand. 1994;89:285–288.CrossRefGoogle ScholarPubMed
30.Lew, T, Tollefson, G. Chlorpromazine-induced neuroleptic malignant syndrome and its response to diazepam. Biol Psychiatry. 1983;18:1441–1446.Google ScholarPubMed
31.Mann, SC, Caroff, SN, Bleier, HR, et al.Electroconvulsive therapy in the treatment of the lethal catatonia syndrome. Convuls Ther. 1990;6:239–247.Google ScholarPubMed
32.Davis, JM, Janicak, PG, Sakkas, P, et al.Electroconvulsive therapy in the treatment of the neuroleptic malignant syndrome. Convuls Ther. 1991;7:111–120.Google ScholarPubMed
33.Kahlbaum, KL. Die Katatonie. Berlin, Germany: Hirschwald; 1874.Google Scholar
34.Kraepelin, E. Psychiatrie. Ein Lehrbuch für Studierende und Ärzte. Leipzig, Germany: Barth; 1899.Google Scholar
35.Bleuler, E. Katatonie mit zweitägigem Zyklus. In: Lehrbuch der Psychiatrie. Berlin, Germany: Springer; 1916:197–205.Google Scholar
36.Mahendra, B. Where have all the catatonics gone? Psychol Med. 1981;11:669–671.CrossRefGoogle ScholarPubMed
37.Goeke, JE, Hagan, DS, Goelzer, SL, et al.Lethal catatonia complicated by the development of neuroleptic malignant syndrome in a middle-aged female. Crit Care Med. 1991;19:1445–1448.CrossRefGoogle Scholar