Abstract
Neuroleptic malignant syndrome (NMS) is a relatively uncommon side effect that may develop after a recent increase in the therapeutic dose of an antipsychotic medication or the addition of a new agent in therapeutic doses.
Case Report
We report a case of NMS developing in a 36-year-old female patient 2 days following deliberate self-poisoning with 30 × 10-mg olanzapine tablets, 7 × 100-mg chlorpromazine tablets and an unknown amount of escitalopram. These were the patient’s own medications. She had not been taking these for several weeks. The patient initially presented with sedation from her overdose which resolved over the next 24 hours. Following this, over the subsequent 24 hours, she became progressively confused, ataxic, hypertonic, ferbrile and tachycardic, with marked lead pipe rigidity of the limbs. Head CT, lumbar puncture and septic screen were all negative. She was treated with intravenous midazolam infusion, nasogastrically administered bromocriptine, external cooling and was mechanically ventilated. She gradually improved over a period of 10 days, with residual confusion lasting another week, and was discharged well with no deterioration from her premorbid neurologic state.
Conclusion
To our knowledge, although there are numerous cases reported with therapeutic use, NMS has not been reported to develop following acute olanzapine overdose. Clinicians should be aware that this may be an uncommon side effect of antipsychotic medication.
Keywords: neuroleptic malignant syndrome, olanzapine, chlorpromazine, deliberate self-poisoning, drug toxicity
Full Text
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Footnotes
There was no outside funding of any kind used for this study.
References
- 1.Goveas JS, Hermida A. Olanzapine induced typical neuroleptic malignant syndrome. J Clin Psychopharmacol. 2003;23(1):101–102. doi: 10.1097/00004714-200302000-00016. [DOI] [PubMed] [Google Scholar]
- 2.Nielsen J, Bruhn AM. Atypical neuroleptic malignant syndrome caused by olanzapine. Acta Psychiatr Scand. 2005;112(2):238–240. doi: 10.1111/j.1600-0447.2005.00578.x. [DOI] [PubMed] [Google Scholar]
- 3.Hall KL, Taylor WH, Ware MR. Neuroleptic malignant syndrome due to olanzapine. Psychopharmacol Bull. 2001;35(3):49–54. [PubMed] [Google Scholar]
- 4.Kontaxakis VP, Havaki-Kontaxaki BJ, Christodoulou NG, et al. Olanzapine-associated neuroleptic malignant syndrome. Prog Neuropsychopharmacol Biol Psychiatry. 2002;26(5):897–902. doi: 10.1016/S0278-5846(02)00202-6. [DOI] [PubMed] [Google Scholar]
- 5.Sierra-Biddle D, Herran A, Diez-Aja S, et al. Neuroleptic malignant syndrome and olanzapine. J Clin Psychopharmacol. 2000;20(6):704–705. doi: 10.1097/00004714-200012000-00021. [DOI] [PubMed] [Google Scholar]
- 6.Morgan M, Hackett LP, Isbister GK. Olanzapine overdose: A series of analytically confirmed cases. Int Clin Psychopharmacol. 2007;22(3):183–186. doi: 10.1097/YIC.0b013e32805aedf5. [DOI] [PubMed] [Google Scholar]
- 7.Cohen LG, Fatalo A, Thompson BT, et al. Olanzapine overdose with serum concentrations. Ann Emerg Med. 1999;34(2):275–278. doi: 10.1016/S0196-0644(99)70243-X. [DOI] [PubMed] [Google Scholar]
- 8.Goveas JS, Hermida A. Olanzapine induced “typical” neuroleptic malignant syndrome. J Clin Psychopharmacol. 2003;23(1):101–102. doi: 10.1097/00004714-200302000-00016. [DOI] [PubMed] [Google Scholar]
- 9.Nielsen J, Bruhn AM. Atypical neuroleptic malignant syndrome caused by olanzapine. Acta Psychiatr Scand. 2005;112(3):238–240. doi: 10.1111/j.1600-0447.2005.00578.x. [DOI] [PubMed] [Google Scholar]
- 10.Philibert RA, Adam LA, Frank FM, et al. Olanzapine usage associated with neuroleptic malignant syndrome. Psychosomatics. 2001;42(6):528–529. doi: 10.1176/appi.psy.42.6.528. [DOI] [PubMed] [Google Scholar]
- 11.Gelenberg AJ, Bellinghausen B, Wojcik JD, et al. A prospective survey of neuroleptic malignant syndrome in a short term psychiatry hospital. Am J Psychiatry. 1988;145:517–518. doi: 10.1176/ajp.145.4.517. [DOI] [PubMed] [Google Scholar]
- 12.Hansan S, Buckley P. Novel antipsychotics and the neuroleptic malignant syndrome. Am J Psychiatry. 1998;155(8):1113–1116. doi: 10.1176/ajp.155.8.1113. [DOI] [PubMed] [Google Scholar]
- 13.Kontaxakis VP, Havaki-Kontaxaki BJ, Christodoulou NG, et al. Olanzapine-associated neuroleptic malignant syndrome: Is there an overlap with the serotonin syndrome? Ann Gen Hosp Psychiatry. 2003;2(1):10–10. doi: 10.1186/1475-2832-2-10. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Pope HGJ, Keck PEJ, McElroy SL. Frequency and presentation of neuroleptic malignant syndrome in large psychiatric hospital. Am J Psychiatry. 1986;143:1227–1233. doi: 10.1176/ajp.143.10.1227. [DOI] [PubMed] [Google Scholar]
- 15.Sachdev P, Mason C, Hadzi-Pavlovic D. Case control study of neuroleptic malignant syndrome. Am J Psychiatry. 1997;154:1156–1158. doi: 10.1176/ajp.154.8.1156. [DOI] [PubMed] [Google Scholar]
- 16.Dunkley EJ, Isbister GK, Sibbritt D, et al. The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity. QJM. 2003;96:635–642. doi: 10.1093/qjmed/hcg109. [DOI] [PubMed] [Google Scholar]
- 17.Keck PE, Pope HG, McElroy SL. Frequency and presentation of neuroleptic malignant syndrome: a prospective study. Am J Psychiatry. 1987;144:1344–1346. doi: 10.1176/ajp.144.10.1344. [DOI] [PubMed] [Google Scholar]
- 18.Stanfield SC, Privette T. Neuroleptic malignant syndrome associated with olanzapine therapy: a case report. J Emerg Med. 2000;19:355–357. doi: 10.1016/S0736-4679(00)00263-8. [DOI] [PubMed] [Google Scholar]
- 19.Apple JE, Van Hauer G. Neuroleptic malignant syndrome associated with olanzapine therapy. Psychosomatics. 1999;40(3):267–277. doi: 10.1016/S0033-3182(99)71247-8. [DOI] [PubMed] [Google Scholar]
- 20.Ozer F, Meral H, Ayadin B, et al. Electroconvulsive therapy in drug-induced psychiatric states and neuroleptic malignant syndrome. J ECT. 2005;21(2):125–127. doi: 10.1097/01.yct.0000159325.08303.45. [DOI] [PubMed] [Google Scholar]
- 21.Scheftner WA, Shulman RB. Treatment choice in neuroleptic malignant syndrome. Convuls Ther. 1992;8(4):267–279. [PubMed] [Google Scholar]
- 22.Rotheke S, Bush D. Neuropsychological sequelae of Neuroleptic Malignant Syndrome. Biol Psychiatry. 1986;21:838–841. doi: 10.1016/0006-3223(86)90249-0. [DOI] [PubMed] [Google Scholar]