Neuroleptic Syndrome Among Patients Receiving Antipsychotic Drugs

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Table of Contents

Introduction
A Review of Neuroleptic Syndrome
Diagnosis
Conclusion
References

Majority of neuroleptic syndrome cases result from side effects of antipsychotic drugs. Patients with such mental illnesses as psychosis tend to be the most affected by this condition. However, there are instances where a patient is brought in for medical attention after an overdose of the drugs. In both cases, it is confirmed that neuroleptic syndrome is brought about by antipsychotic drugs. The only way to ascertain the extent of the disorder is through a conclusive analysis of the symptoms presented by a patient who has been treated with antipsychotic drugs. Neuroleptic syndrome is a very serious condition that should not be ignored. To this end, the diagnosis criteria should be analyzed carefully.

Key Words: Neuroleptic syndrome, Antipsychotic drugs, Diagnosis criteria, Side effects, Mental illness

Introduction

Neuroleptic syndrome is one of the conditions reported among patients undergoing a neurological examination. Interestingly, it is noted that the condition is rare in the neurological field. The syndrome results from the side effects of antipsychotic medication [Berman BD, 2011]. That is why it is commonly associated with patients undergoing receiving mental health services. The syndrome is accompanied by a number of symptoms. For example, it is characterized by hyperthermia and muscle rigidity. In other cases, patients experience significant changes in their cognitive abilities [Gurrerra Ri, 2011]. The syndrome is regarded by professionals as a deadly mental condition, although alterations of the antipsychotic prescriptions have helped to reduce the number of reported cases.

In the larger field of psychiatry, patients with this condition receive various forms of medications in efforts to alleviate their symptoms. Depending on the nature of the diagnosed condition, practitioners prescribe medications intended to control or minimize the effects of the syndrome on the overall health of the patient. One such psychiatric disorder is psychosis. Patients who suffer from this mental disorder tend to experience hallucinations and delusions [CroakinPE, 2008]. The medication given to such patients is what constitutes the antipsychotic drugs [El-gaaly S, 2009].

There are two types of antipsychotic medications. They include the first and the second generation drugs. When administered to a patient, they tend to localize their action to the brain’s dopamine pathways [Mitsuro N, 2012]. They achieve this by blocking the receptors in this region. Clozapine and olanzapine are two common examples of antipsychotic drugs [Manu P, 2011]. Neuroleptic syndrome resulting from these drugs is more evident in cases where typical antipsychotic medication is used.

A Review of Neuroleptic Syndrome

Research is ongoing to determine the pathophysiology of neuroleptic syndrome [Nakara M, 2012]. Studies reveal that the aforementioned blockage of receptors in the brain of the patient is what contributes to the development of the disorder [Khaldi S 2007]. The receptors that are affected by this blockage include the D₂.

Butwicka et al. carried out a study to examine the syndrome among patients with a CYP2D6 deficiency. Adolescents were the participants in this study. The findings made indicated that the patients had high concentrations of antipsychotic drugs in their systems. The symptoms exhibited by the patients indicated that they were afflicted by the neuroleptic syndrome. As a result, the researchers established a link between the drugs used by the patients and the disorder.

Diagnosis

Like in any other medical disorder, a patient suffering from neuroleptic syndrome will exhibit certain symptoms unique to the condition. The most common symptom involves sustained mental instability [Yang CW, 2012]. Such patients generally display some sense of unease in their normal levels of ‘stability’. In addition, the condition is characterized by extrapyramidal symptoms. In such cases, a patient is unable to initiate movement owing to impediments in their locomotive abilities [Peterson AB, 2014]. Another trait associated with neuroleptic syndrome is hyperpyrexia. In this case, the patient experiences an extremely high fever [Perry PJ 2012]. Detection of any of these symptoms is enough grounds to carry out a diagnosis.

Compared to other common neurological conditions, diagnosis of neuroleptic syndrome is not straightforward. The most obvious reason for this absence of a proper diagnosis framework is the lack of consensus among practitioners with regards to the most preferred approach (SA YK, 2013). However, there are few publications that make reference to the criteria used in diagnosing this condition. In most cases, clinicians are able to identify the disorder by relying on the symptoms presented.

One such publication that makes reference to possible diagnostic criteria is The Diagnostic and Statistical Manual of Mental Disorders. The manual explains that an analysis of the condition should begin with the identification of the main symptoms associated with it [Sokoro AA, 2011]. Thus, when a patient complains of a high fever, which is accompanied by severe rigidity of their muscles after using antipsychotic drugs, there are enough grounds to believe that they might be suffering from the disorder.

A complete diagnosis must ensure that the patient exhibits additional symptoms. Such other symptoms include mutism, elevated blood pressure, and dysphagia. Incontinence and disphoresis are also evident among such patients (Trollor NJ, 2012). A complete diagnosis requires a patient to exhibit two of the additional symptoms [Seitz DP, 2009]. When presented together with fever and muscle rigidity, such traits as leukocytosis make for a strong diagnosis.

Figure 1 below is an illustration of a scan to verify leukocytosis that is associated with the condition. Such scans help practitioners to detect the syndrome early enough to minimize fatalities.

Fatality in neuroleptic syndromes is associated with cystic leukocencephalopathy. Figure1 is an MRI of a patient who had an overdose of olonzapine, venlafaxine, quetipine, and propranolol. The four are common antipsychotic drugs. As evidenced by the white matter in the MRI, the patient has developed cystic leukocencephalopathy [Picard SL, 2008].

A test for the leukocyte count in an individual helps to strengthen the diagnosis. The reason is that a reduced count increases the possibilities of the syndrome’s presence. It is important to appreciate that neuroleptic syndrome can be experienced in various degrees. As such, a practitioner is advised to adopt a critical diagnostic approach. Table 1 explains the criteria for the determination of the disorder. The table makes a case for major and minor manifestations of neuroleptic syndrome.

Table1: Diagnostic Criteria for Neuroleptic Syndrome

MANIFESTATION SYMPTOM	MINOR	MAJOR
Fever		X
Leukocytosis	X
Tachycardia	X
Tachypoea	X
Muscle Rigidity		X
Altered consciousness	X
Elevated Creatine	X
Abnormal blood pressure	X
Elevated creatine		X
Phosphokinase Level		X

In the table, ‘X’ indicates the symptom corresponding to the degree of the syndrome’s manifestation. However, it is important to note that the said diagnosis should be arrived at under certain circumstances. It should be made in the event that toxicology report suggests the presence of a particular antipsychotic drug [Nasijima K, 2013]. Such an approach confirms that neuroleptic syndrome is a side effect of antipsychotic drugs.

Sa et al. carried out a study to determine the relationship between olanzapine and the malignant form of neuroleptic syndrome. In their study, they found that schizophrenic patients using the antipsychotic drug exhibited symptoms that suggested they had acquired the syndrome. The study confirmed that neuroleptic syndrome results from the use of such antipsychotics. Patients suffering from schizophrenia and psychosis are usually given the same drug, albeit in different doses [Patra BN, 2013].

In a literature review, Croarkin, Emslie, and Mayes sought to determine whether the symptoms are exhibited differently or not depending on one’s age. The information obtained was limited to patients below 18 years. The study by Croarkin et al. revealed that between 1991 and 2007, prevalence of the syndrome was higher among adults compared to teenagers. The findings established a link between the condition and age. To this end, the study indicated that the symptoms associated with this disorder were similar among adults [Mitsuro N, 2012].

Regardless of the prevalence disparities between adults and children, psychiatrists are advised to exercise caution when making antipsychotic prescriptions to young patients [Khaldi S, 2007]. The argument is based on the undeniable fact that neuroleptic syndrome is closely associated with the unintended effects of these drugs. Antipsychotic medication poses health risks to children given their low levels of immunity. As such, practitioners in this field are encouraged to handle their young patients with a lot of care.

Conclusion

The malignant version of neuroleptic syndrome is quite rare [SA YK, 2013]. However, the risk of fatality is high regardless of whether the condition is malignant or not. Due to this, questions are raised with regards to the preferred treatment approach. The mere fact that one can be accurately diagnosed with the condition is not enough to address these concerns. In their study, Berman points out that the first step in dealing with this syndrome is to ensure that the effects of the causative agent are dealt with as soon as possible. The treatment option should be implemented fast enough to reduce chances of fatality.

References

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