Psychiatry and Clinical Psychopharmacology

Childhood and adolescence disorders Neuroleptic malign syndrome during antipsychotic treatment with lithium: two adolescent patients with bipolar disorder

Psychiatry and Clinical Psychopharmacology 2013; 23: Supplement S174-S175
Read: 662 Published: 20 March 2021

Neuroleptic malignant syndrome (NMS) was first identified in 1968 and it is one of the most feared complications of neuroleptic drugs. Case reports of NMS development in children and adolescents following the use of antipsychotic drugs have increased in recent years. In this article we aimed to present two bipolar adolescent cases that had NMS while they were using antipsychotics and lithium, and they were treated with bromocriptine, successfully. The treatment follow-up of two cases was presented in this section. Case I: A 15-year-old female, who applied to a psychiatry centre with aggression, talking too much, insomnia, irritation and was diagnosed as bipolar disorder, She was administered 1200 mg lithium per day and zuclopenthixol accuphase twice a week; after two days she had dryness of the mouth, prolonged sleeping and then failure in talking; five days later she had tremor in her hands, rigidity in her legs and neck then she could not walk. Because of these complaints her family had decided to stop using these drugs. Two days after discontinuation since her complaints resisted, they applied to emergency service. In psychiatric examination; somnolence, dystonia, diffuse muscular rigidity, şuctuation of autonomic functions was observed, so NMS was thought as an initial diagnosis. She was monitorized in intensive care unit and she was treated with bromocriptine and biperiden. Case 2: A 16-year-old male, who applied to Dokuz Eylul Faculty of Medicine, Child and Adolescent Psychiatry Outpatient Unit with the symptom of talking too much, increasing energy, motor hyperactivity, grandiosity, visual and auditory hallucinations and insomnia. He was diagnosed with psychotic mania. Risperidone treatment was initiated. His symptoms were resistant and he was hospitalized.Lithium treatment was started at a dose of 300 mg per day and the cross titration from risperidone to aripiprazole was made because of high prolactin levels. On the twenty sixth day of his hospitalization, his body temperature was measured as 38,5 C; blood pressure was between 80/50 and 100/60 mmHg. He had dystonia, diffuse muscular rigidity, mutism, tremor, tachycardia, and diaphoresis. His leukocyte count was 11700/mm3, CK: 419 U/L. Diagnosis of NMS was judged; antipsychotics and lithium were stopped, he was administered bromocriptine, i.v. hydration, antipyretics; his leukocyte level and CK was controlled on daily basis. We diagnosed NMS during antipsychotic and lithium treatment in two bipolar adolescents. Some adolescents with affective disorders might be more vulnerable to the development of NMS. More importantly, bipolar disorder is one of the most common serious psychiatric disorders of adolescence and it can be complicated by psychotic symptoms. Therefore, the use of neuroleptics may be introduced early in the management of psychotic symptoms in adolescents with primary affective disorder. According to our experiences, diagnosis and treatment of NMS in early stages lead to less complications and bromocriptine is useful in bipolar adolescents with NMS.

EISSN 2475-0581