A malignant neuroleptic syndrome is called ...

Malignant neuroleptic syndrome is a rare and life-threatening disorder caused by the use of psychotropic medications, especially neuroleptics belonging to groups of phenothiazines, thioxanthenes and butyrophenones. Provoke drugs such as amphetamine, Amoxaline, Fluoxetine, Desipramine, Fenelzin, cocaine or Metoclopramide to provoke NSA.

Causes

Factors of probability of neuroleptic syndrome formation can be:

• Taking long-acting drugs;
• Use of highly flammable means;
• The use of drugs available to the NSA, together with anticholinergic medicines;
• Antidepressants;
• air temperature;
• Electroconvulsive treatment and increased humidity.

The aggravation of the disease can cause causes directly related to the physiological state of the patient. To such belong:

• Dehydration of the body;
• Psychomotor irritation;
• alcoholism;
• Mental retardation ;
• Postpartum period;
• Intercurrent infection;
• Lack of iron;
• Physical exhaustion;
• Craniocerebral trauma;
• Thyroid dysfunction.

The state of incoherence, old age, emotional nervousness, male sex - all this also aggravates malignant neuroleptic syndrome. Symptoms of ZNR can be completely different - from insignificant to tangible.

An Easy Variety of Development

Malignant neuroleptic syndrome is characterized by the following indications: the temperature rises to low-grade figures, there are small somato-vegetative failures (pulse BP within 150 / 90-110 / 70 mm Hg, tachycardia - up to 100 beats per minute), as well as abnormalities in laboratory data (An increase in ESR to 18-30 mm / h, a low number of lymphocytes - from 15 to 19%). There are no homeostasis disorders and hemodynamic growth. The psychopathological condition is formed by onyeroid-catatonic or affective-delirious attacks.

Average degree

The fact that a person is ill with a malignant neuroleptic syndrome of an average degree is indicated by the following symptoms:

• Manifested somatovegetative disorders (asthma with tachycardia up to 120 beats per minute);
• Elevated body temperature (up to 38-39 degrees);
• Tangible changes in laboratory data (ESR up to 35-50 mm / h, and leukocytosis - up to 10J109 / l, the number of leukocytes decreases to 10-15%);
• The level of creatine phosphokinases and transaminase in the blood increases;
• Moderate hypokalemia and hypovolemia are noted.

The psychopathological appearance is characterized by impairment of a sense of an affective and one-degree degree. Catatonic symptoms are manifested by immobility with negativism, frequent (in the evenings) cases of irritation with nervousness, motor and speech stereotypes.

Difficult process

Against the background of hyperthermia can also occur malignant neuroleptic syndrome. Symptoms are more serious, namely:

• Somatovegetative failures increase (dyspnea up to 30 breaths per 1 minute, tachycardia reaches 120-140 beats per minute);
• Increase water-electrolyte disorders;
• Hemodynamic disturbances increase.

The greatest change in symptoms is found in laboratory figures. ESR increases up to 40-70 mm / h, leukocytes - 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 confusion of the mind can reach comatose, co-ordinate and amenable levels. Stupor, negativism, chaotic irritation, lethargy with a decrease in muscle tone, and in especially serious cases and absolute immobility with areflexia - all this malignant neuroleptic syndrome.

Treatment

Timely determination of ailment is the main point. The fact that a person is ill with malignant neuroleptic syndrome can indicate muscle tension, tachycardia, fever, hypertension, increased sweating, detected after taking antipsychotics, dysphagia.

The first thing a doctor should do is to cancel neuroleptics and other neurotoxic drugs. Also, support procedures are needed to bring down the temperature and fill the lack of fluid. Electrolyte imbalance should be excluded. It is compulsory to carry out careful monitoring of respiratory activity, the work of which can be repeatedly violated in the formation of serious muscle rigidity and helplessness to cough up bronchial secretion.

It is necessary to closely monitor the function of the kidneys. However, there is no evidence that the osmotic department speeds up the amendment after NSA, it can simply help support kidney work. It is often necessary to produce therapy in an environment of enhanced treatment.

Drug therapy

To treat the malignant neuroleptic syndrome with medicines is desirable in difficult cases. For this, muscle relaxants ("Dantrolen") or dopamine agonists ("Amantadine" and "Bromocriptine") are used. Mortality is reduced with the use of both types of drugs. Doses are freely changed, however, for "Bromocriptine" in the sources receptions in sizes from 2.5 and up to 5 mg 3 times a day are described orally.

Dopamine agonists, especially in large portions, can provoke psychosis or vomiting, and this can significantly aggravate the state of health of a patient with a malignant neuroleptic syndrome. The direct muscle relaxant is used with doses of 10 mg / kg. The purpose of its application is to reduce muscle stiffness, as well as the metabolism of skeletal muscles, the increase of which is partially responsible for hyperthermia. "Dantrolen" is characterized by hepatotoxicity, it can provoke hepatitis and even death as a result of liver failure. And then there will be no longer any point in further treating the malignant neuroleptic syndrome.

ZNS is also eliminated by a combination of dopamine agonists and Dantrolene. Anticholinergic drugs, widely used for the treatment of pseudoparkinsonism, caused by neuroleptics, do not provide significant results, moreover, they can further disrupt thermoregulation.

There is recent information about the efficacy of "carbamazepine", which in many patients showed a rapid weakening of the CNS. True, there is no reliable data on the effectiveness of benzodiazepines for the treatment of this syndrome. However, when the condition improves, these drugs can be useful in reducing irritation in patients with a malignant neuroleptic syndrome.

Hyperthermia

The disease can be detected approximately once per 100,000 anesthesia using depolarizing muscle relaxants ("Miorelaxin", "Ditilina" and "Listenon"), as well as inhalation anesthetics from the number of halogenated hydrocarbons (Methoxyflurane, Fluorogana and Galotana) . Hyperthermia appears in patients with a high susceptibility to these drugs, which is interrelated with malfunctions of calcium metabolism in muscle masses. The result is generalized muscle twitching, and sometimes a muscle disease, resulting in a huge amount of heat, body temperature instantaneously reaches 42 degrees. Malignant neuroleptic syndrome causes death in 20-30% of cases.

Ambulance

If there is a fast-growing hyperthermia, you should stop taking the above medicines. From anesthesia drugs that do not provoke an ailment, it is possible to allocate barbiturates, "Pankuronium", "Tubokurarin" and nitrous oxide. Just they should be used if it is necessary to extend anesthesia.

Due to the probability of formation of ventricular arrhythmia, preventive use of "Phenobarbital" and "Procainamide" in therapeutic dosages is prescribed. It is also necessary to prepare cooling procedures by placing containers with cold water or ice over large blood vessels. It is required to immediately normalize the inhalation of air, to inject sodium bicarbonate IV (400 ml of a 3% solution). In hazardous cases, resuscitation is recommended. Hospitalization is the first thing to do if there is a malignant neuroleptic syndrome.

Forecast

Present in the history of the NSA always increases the likelihood of a secondary course of this condition and complicates the course of the prevailing malaise. Moreover, the disorders that arise with this syndrome almost never pass the brain structure without traces, creating those or other neurological disorders. So what is a malignant neuroleptic syndrome? It is a disease that significantly worsens a person's life, and even can lead to death.