Posted by Sunnely on December 5, 2000, at 19:53:34
In reply to Re: Olanzapine and side effects » Sunnely, posted by SLS on December 4, 2000, at 22:05:33
> Sunnely - Thank you for contributing another one of your thoroughly informative replies.
>
> There is an obvious similarity in the presentation of NMS with serotonin syndrome. How are they differentially diagnosed?
>
> Thanks again.++++++++++++++++++++++++
Hi Scott,
Indeed, neuroleptic malignant syndrome (NMS) and serotonin syndrome (SS) have significant similarity in clinical features.
The following are general differences between the two:
1) DRUGS INVOLVED:
NMS - neuroleptics (aka antipsychotics); SS - serotonergic drugs (especially in combination)2) CAUSE(S) OR MECHANISM(S) PROPOSED:
NMS - central (brain) dopamine deficiency; SS - Activation of 5HT1A receptors; enhancement of overall 5HT neurotransmission.3) ONSET:
NMS - full syndrome usually 3-9 days of start of antipsychotic (but can occur anytime); SS - usually within hours4) RIGIDITY:
NMS - more; SS - less5) AUTONOMIC DYSFUNCTION (e.g., fluctuating BP, profuse sweating, rapid pulse, breathing, etc.):
NMS - more; SS - less6) HYPERREFLEXIA, RESTLESSNESS, UNSTEADY GAIT, MYOCLONUS:
NMS - less; SS - more7) AVERAGE DURATIION:
NMS - longer (especially if depot antipsychotics are involved); SS - shorter8) MORTALITY:
NMS - higher; SS - lowerNo diagnostic or laboratory tests to confirm diagnosis of SS or NMS. CPK level is usually elevated in both.
Aside from serotonin syndrome, other conditions that can be mistaken for NMS include: 1) Malignant Hyperthermia (during general anesthesia), 2) Lethal Catatonia, 3) Central Anticholinergic Toxicity (e.g., tricyclic antidepressant overdose), 4) Neuroleptic-related Heatstroke (especially during heat wave).
poster:Sunnely
thread:938
URL: http://www.dr-bob.org/babble/20001130/msgs/49997.html