Malignant antipsychotic syndrome is a rare and life-threatening disorder caused by taking psychotropic drugs, especially antipsychotics belonging to the groups of phenothiazines, thioxanthenes and butyrophenones. The use of drugs such as amphetamine, Amoxaline, Fluoxetine, Desipramine, Fenelzin, cocaine or Metoclopramide can provoke ZNS.
Causes
The probability factors for the formation of antipsychotic syndrome can be:
- prolonged exposure;
- the use of potent means;
- the use of drugs for ZNS along with anticholinergic drugs;
- antidepressants;
- air temperature;
- electroconvulsive treatment and high humidity.
The aggravation of the disease can cause causes directly related to the physiological well-being of the patient. These include:
- dehydration of the body;
- psychomotor irritation;
- alcoholism;
- mental retardation ;
- the postpartum period;
- intercurrent infection ;
- lack of iron;
- physical exhaustion;
- head injuries;
- thyroid dysfunction.
The state of incoherence, old age, emotional nervousness, male gender - all this also exacerbates the malignant antipsychotic syndrome. Symptoms of ZNR can be completely different - from insignificant to tangible.
Easy development
Malignant antipsychotic syndrome is characterized by the following indications: the temperature rises to subfebrile numbers, small somatovegetative failures occur (blood pressure pulse within 150 / 90-110 / 70 mm Hg, tachycardia up to 100 beats per minute), as well as deviations in laboratory data (increase in ESR up to 18-30 mm / h, low number of lymphocytes - from 15 to 19%). There are no disorders of homeostasis and hemodynamic growth. The psychopathological state is formed by oneiric-catatonic or affective-delusional attacks.
Medium grade
The fact that a person is sick with malignant neuroleptic syndrome of moderate degree is indicated by the following signs:
- manifested somatovegetative disorders (asthma with tachycardia up to 120 beats per minute);
- increased body temperature (up to 38-39 degrees);
- noticeable changes in laboratory data (ESR increases to 35-50 mm / h, and leukocytosis - to 10J109 / l, the number of leukocytes decreases to 10-15%);
- the level of creatine phosphokinases and transaminase in the blood increases;
- moderately detected hypokalemia and hypovolemia are noted.
The psychopathological type is characterized by impaired feelings of an amentine-like and oneiric degree. Catatonic symptoms are manifested by immobility with negativism, an increase (in the evenings) of cases of irritation with nervousness, motor and speech stereotypes.
Difficult process
Against the background of hyperthermia, a malignant antipsychotic syndrome can also occur. Symptoms are already more serious, namely:
- somatovegetative malfunctions intensify (shortness of breath up to 30 breaths in 1 min., tachycardia reaches 120-140 beats per minute);
- water-electrolyte disorders increase;
- hemodynamic disturbances increase.
The greatest change in symptoms is detected in laboratory numbers. ESR increases to 40-70 mm / h, white blood cells - up to 12J109 / l, the number of lymphocytes decreases to 3-10%, the degree of creatine phosphokinases, aspartic and alanine transaminases in the blood significantly increases. The stupefaction of the mind can reach comatose, soporotic and amenitic stages. Numbness, negativity, chaotic irritation, lethargy with a decrease in muscle tone, and in especially serious cases, absolute immobility with areflexia - all this is a malignant antipsychotic syndrome.
Treatment
Timely determination of the disease is the main point. Muscle tension, tachycardia, fever, hypertension, increased sweating detected after taking antipsychotics, and dysphagia can indicate that a person is sick with a malignant antipsychotic syndrome.
The first thing a doctor should do is to cancel antipsychotics and other neurotoxic drugs. Supportive procedures will also be required to bring down the temperature and make up for the lack of fluid. Electrolyte imbalance should be ruled out. It is imperative to carefully monitor respiratory activity, the work of which can be disturbed repeatedly during the formation of severe muscle rigidity and helplessness to cough up bronchial secretions.
You need to carefully monitor kidney function. However, there is no evidence that the osmotic department accelerates the correction after ZNS, it just can help support kidney work. Often, it is required to produce therapy in an environment of enhanced treatment.
Drug therapy
It is desirable to carry out the treatment of malignant antipsychotic syndrome with medications in complex cases. For this, muscle relaxants (Dantrolene) or dopamine agonists (Amantadine and Bromocriptine) are used. Mortality is reduced with both types of medication. Doses freely change, however, for "Bromocriptine" the sources describe techniques in sizes from 2.5 to 5 mg 3 times a day orally.
Dopamine agonists, especially in large portions, can provoke psychosis or vomiting, and this can significantly aggravate the patient's well-being with malignant antipsychotic syndrome. Direct-acting muscle relaxant is used with doses of 10 mg / kg. The purpose of its use is to reduce muscle stiffness, as well as skeletal muscle metabolism, the increase of which is partially responsible for hyperthermia. "Dantrolene" is characterized by hepatotoxicity, it can provoke hepatitis and even death as a result of liver failure. And then there will no longer be any sense in further treating the malignant antipsychotic syndrome.
ZNS is also eliminated by a combination of dopamine agonists and Dantrolene. Anticholinergics, widely used for the treatment of pseudoparkinsonism due to antipsychotics, do not provide significant results, moreover, they can further disrupt thermoregulation.
There is recent information about the effectiveness of "carbamazepine", which in many patients showed a rapid weakening of the indications of the central nervous system. True, there is no reliable data on the effectiveness of the use of benzodiazepines for the treatment of this syndrome. However, when the condition improves, these drugs may be useful to reduce irritation in patients with malignant antipsychotic syndrome.
Hyperthermia
The disease can be detected approximately once per 100 thousand anesthesia using depolarizing muscle relaxants (Miorelaxin, Ditilin and Listenon), as well as inhaled anesthetics from the number of halogen-substituted hydrocarbons (Methoxifluran, Fluorogan and Halotan) . Hyperthermia appears in patients with a high susceptibility to these drugs, which is interconnected with malfunctions of calcium metabolism in muscle mass. The result is generalized muscle twitching, and sometimes muscle disease, resulting in a huge amount of heat, body temperature instantly reaches 42 degrees. Malignant antipsychotic syndrome causes death in 20-30% of cases.
Ambulance
If fast-growing hyperthermia is detected, you must stop taking the above drugs. Of the anesthetics that do not provoke the disease, barbiturates, Pankuroniy, Tubokurarin and nitrous oxide can be distinguished. Just they should be used if necessary, prolongation of anesthetic care.
Due to the likelihood of ventricular arrhythmia formation, the prophylactic use of Phenobarbital and Procainamide in therapeutic dosages is prescribed. Cooling procedures should also be prepared by placing containers of cold water or ice over large blood vessels. It is required to immediately normalize the inhalation of air, inject iv sodium bicarbonate (400 ml of a 3% solution). In dangerous cases, the implementation of resuscitation measures is recommended. Hospitalization is the first thing to do if a malignant antipsychotic syndrome is detected.
Forecast
A history of ZNS always increases the likelihood of a secondary course of such a condition and complicates the course of the prevailing malaise. Moreover, the disorders that arise in this syndrome almost never pass the brain structure without a trace, creating one or another neurological disorder. So what is malignant antipsychotic syndrome? This is a disease that significantly worsens a person’s life, and even can lead to death.