But patients with organic lesions of the central nervous system - a history of head injury, cerebral atherosclerosis, etc., and especially patients with Lewy body dementia or Parkinson's disease are especially predisposed to the occurrence of NMS. NMS most often develops when prescribing or increasing the dose of powerful, high-potency typical antipsychotics (such as haloperidol, mazeptil, clopixol, triftazine, moditene). Especially in high doses, when prescribing long-acting forms of antipsychotics. Also with the simultaneous administration of several antipsychotics, with the parallel administration of lithium, antidepressants. In case of insufficient doses of correctors or, on the contrary, overcorrection, causing anticholinergic side effects.
- It is a myth that atypical antipsychotics do not or rarely cause NMS!
- It is also a myth that only high doses of NL cause NMS.
- But nevertheless, it is possible for them too, and this should be kept in mind.
- Typically, NMS develops in the first 30 days (usually in the first 1-2 weeks) from the prescription or increase in the dose of NL or from the withdrawal/reduction of the dose of the corrector, but it can occur at any time, sometimes after months, years and even decades of problem-free and smooth therapy with this drug antipsychotic.
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Another way they cause it, and they cause it in proportion to their D2-blocking activity and ability to cause EPS, is that risperidone, paliperidone, and amisulpride cause NMS much more often than olanzapine, ziprasidone, and aripiprazole. Cases of NMS due to quetiapine and clozapine are extremely rare, with only a few cases described in the literature.
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NMS is an individual idiosyncratic, hyperergic reaction of the body to a particular NL or to a class of NL. And although it happens more often at high doses, it also happens at small and even very small doses. Sometimes even a short stay of the patient in the room where the injections of this NL were made, and inhalation of the vapors of this NL, is enough for NMS to develop. And such cases are described in the literature. Provoking factors and timing.
Dehydration of patients also plays a role in the development of NMS, for example due to insufficient drinking, high ambient temperature, electrolyte disturbances (for example, due to recent diarrhea or vomiting, anorexia). The presence of painful conditions influences. For example, intercurrent diseases, especially those occurring with fever, exhaustion of patients (nutritional or for another reason), hypoglycemia with insufficient carbohydrate nutrition, hypoproteinemia/hypoalbuminemia (leads to an increase in the free fraction of NL)
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In addition, iron deficiency (increases the severity of EPS, especially akathisia), overcrowding of patients, poor sanitary conditions, endocrine disorders in the patient. NMS, as a rule, develops from the appearance of the first symptoms to a maximum within 1-2-3 days. Sometimes lightning-fast development occurs; only a few hours pass from the first signs to the peak. Fulminant forms are especially fatal. The duration of NMS is from several days to 30-40 days, usually 1-2 weeks (mild forms - several days).
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Treatment of neuroleptic malignant syndrome. Therapy of neuroleptic syndrome, especially in its complicated malignant form, is represented byis a complex multi-stage process. In addition to buy phenergan pills actions, it requires subtle corrective actions. Neuroleptic malignant syndrome.
This is a very rare, but extremely life-threatening condition, explained in most cases by a pronounced side effect from taking certain psychotropic drugs. And it does not require self-pity or ever-increasing doses of painkillers, but emergency help. In other words, neuroleptic malignant syndrome is essentially an acute poisoning. Therefore, if any clinical manifestations occur (we will discuss the symptoms in detail in the corresponding section), you should immediately call an ambulance, and not look for a place in the cemetery. We assure you that you will still have time to get there. But if you act quickly, then not this time!
How common is neuroleptic malignant syndrome (NMS)? Most authors indicate that among patients treated with promethazine drugs or high-potency neuroleptics, the incidence rate ranges from 0.02% to 3.23% (according to some sources - up to 12.2%). If the treatment was based on low-potency drugs, neuroleptic syndrome occurs somewhat less frequently (from 0.02% to 1.4%). It has also been noted that the use of the latest pharmacological agents (released in the 1990s - 2000s) and the gradual abandonment of traditional medications significantly reduces the likelihood of developing NMS (down to 0.01%).