By Peter M. Haddad, Serdar Dursun, Bill Deakin
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Extra resources for Adverse syndromes and psychiatric drugs: a clinical guide
Fricchione G, Mann SC, and Caroff SN (2000). Catatonia, lethal catatonia, and neuroleptic malignant syndrome. Psychiatric Ann, 30, 347–55. Friedman JH, Feinberg SS, and Feldman RG (1985). A neuroleptic malignant-like syndrome due to levodopa therapy withdrawal. JAMA, 254, 2792–5. Fujitake J, Kuno S, and Nishitani H (1984). Neuroleptic malignant syndrome-like state in eight patients with parkinsomnism. Rinsho Shinkeig’aku (Clin Neurol), 24, 371–8. Gelenberg AJ, Bellinghausen B, Wocjik JD, et al.
Imipramine, the TCA involved in the early reports, possesses weak serotonin reuptake inhibitor (SRI) capacity which is usually insufficient to precipitate serotonin toxicity, even if combined with MAOIs. Following the introduction of clomipramine, more severe reactions were reported in combination with MAOIs, reflecting the fact that clomipramine is a more potent blocker of serotonin reuptake than imipramine. This variation, and the unpredictability of reactions with imipramine, caused confusion in the literature, especially because the mechanism of the reaction was not widely understood by clinicians until the 1980s (despite extensive evidence from animal work).
Reduce antipsychotic dose Management Switch antipsychotic Prescribe either an anticholinergic, benzodiazepine or propranolol. Try to prevent the condition by gradual titration of dosage when starting or increasing amount of antipsychotic medication. Further reading Braude WM, Barnes TRE, and Gore SM (1983). Clinical characteristics of akathisia: a systematic investigation of acute psychiatric inpatient admissions. British Journal of Psychiatry, 143, 139–50. Halstead SM, Barnes TRE, and Speller JC (1994).
Adverse syndromes and psychiatric drugs: a clinical guide by Peter M. Haddad, Serdar Dursun, Bill Deakin