PDF(Pubmed)
Abstract：
Neuroleptic malignant syndrome (NMS) is a severe adverse reaction associated with neuroleptic or antipsychotic drugs. This case report discusses a 43-year-old man with a history of bipolar disorder and polysubstance abuse who presented with altered mental status, autonomic dysfunction, and muscular rigidity. The patient had recently started on ziprasidone, a second-generation antipsychotic, leading to an atypical presentation of NMS. Unlike classic findings associated with NMS induced by first-generation antipsychotics, this case lacked high fever, lead pipe rigidity, or elevated creatine kinase levels greater than 1000 on initial presentation. The delay in diagnosis was attributed to the milder symptoms and absence of typical findings, resulting in extensive diagnostic workup and interventions. The patient responded positively to treatment with lorazepam based on the Woodbury severity stage guidelines. This case underscores the complexity of diagnosing NMS induced by second-generation antipsychotics and highlights the need for awareness and tailored treatment approaches for atypical presentations.
摘要：
抗精神病药恶性综合征（NMS）是与抗精神病药或抗精神病药相关的严重不良反应。该病例报告讨论了一名43岁的男性，他有双相情感障碍和多物质滥用的病史，并表现出精神状态的改变。自主神经功能障碍,肌肉僵硬。病人最近开始服用齐拉西酮,第二代抗精神病药,导致NMS的非典型呈现。与第一代抗精神病药物诱导的NMS相关的经典发现不同，这个病例没有高烧，铅管刚度,或最初出现时肌酸激酶水平升高超过1000。诊断的延迟归因于症状较轻，没有典型的发现，导致广泛的诊断工作和干预措施。根据Woodbury严重程度阶段指南，患者对劳拉西泮治疗反应积极。该病例强调了诊断第二代抗精神病药引起的NMS的复杂性，并强调了对非典型表现的意识和量身定制的治疗方法的需求。
