Frequency of pattern of clinical and laboratory features in patients presenting with neuroleptic malignant syndrome

Abstract

Objectives. Neuroleptic malignant syndrome (NMS) is a life-threatening adverse reaction of antipsychotic drugs, especially of dopamine receptor antagonists (DRA’s). Excitation, exuberant behavior, violent behavior and lack of insight predispose the patients to the use of depot preparations and high doses of the antipsychotics. These behaviors also make the patients suffer from dehydration leading to cognitive impairment, confusion and incontinence. In addition to clinical and pharmacological risk factors, legal and ethical risk factors may be contributory towards the incidence, diagnosis and prognosis of NMS in Pakistan. Material and methods. This study was conducted as a descriptive, observational study to determine the frequency of deranged pattern of clinical and laboratory feature patients presenting with Neuroleptic Malignant Syndrome at Department of Neurology, Jinnah Postgraduate Medical Center (JPMC), Karachi. Data was prospectively collected from patients after taking a verbal consent. 55 patients who met the diagnostic criteria were included. Quantitative data was presented as simple descriptive statistics giving mean and standard deviation and qualitative variables was presented as frequency and percentages. Effect modifiers were controlled through stratification to see the effect of these on the outcome variable. Post stratification chi square test was applied taking p-value of ≤0.05 as significant. Outcomes. A total of 55 patients who met the inclusion and exclusion criteria were included in this study. Mean age, duration of NMS symptoms, length of hospital stay, SBP and DBP in our study was 39.41±12.67 years, 10.56±7.29 hours, 9.74±3.21 days, 135.87±10.97 mmHg and 83.21±6.42 mmHg. 24 (43.6%) and 31 (56.4%) were male and female. Out of 55 patients, 81.8%, 38.2%, 69.1%, 56.4%, 47.3%, 74.5% and 25.5% had fever, autonomic dysfunction, EPS symptoms, altered GCS, elevated CPK, elevated WBC and abnormal LFT. Conclusions. NMS is an important preventable clinical entity. Early diagnosis and judicious use of antipsychotics is warranted to prevent mortality and heightened morbidity.

Keywords

• neuroleptic malignant syndrome
• movement disorders
• neurohospitalist
• antipsychotics and predisposing factors