Neuroleptic Syndrome

Neuroleptic syndrome (NMS) is a rare, but life-threatening condition - a peculiar reaction of the body to neuroleptic drugs, which is characterized by the appearance of increased body temperature, muscle rigidity, changes in the mental state, and disturbance of the regulation of the autonomic nervous system. NMS most often develops soon after initiation of treatment with neuroleptics, or after increasing the dosage of medications taken.

[1], [2], [3], [4]

Epidemiology

Neuroleptic syndrome occurs with a frequency of 0.07-2.2% of cases in patients taking antipsychotics. It is more common in men than in women in a ratio of 2: 1. The average age of the patient is 40 years.

If the treatment of the underlying disease has already begun, then the incidence of neuroleptic syndrome will be envied by several factors - the chosen medication, the physical and mental state of the patient, the head trauma suffered. The first signs develop already at the beginning of treatment, for 15-21 days. The third part of NA cases is more likely to be associated with the peculiarities of the treatment regimen - rapid growth of the dosage or the introduction of additional groups of drugs that have an enhanced effect. One example - in the treatment of aminazine and haloperidol, for a more rapid achievement of the antipsychotic effect. Also extrapyramidal changes can become acute and because of the abrupt cancellation of lekartsv - "withdrawal syndrome".

Neuroleptic syndrome and malignant neuroleptic syndrome develop not only in patients with healthy psyche, but also in those who have a history of schizophrenia, affective disorders, schizoaffective psychosis, as well as brain pathologies obtained in utero or in labor (toxicosis in pregnancy with the mother, prematurity, mother-borne infections in the first half of pregnancy, umbilical cord entanglement and suffocation, birth trauma, prematurity). These facts indicate that the patient's brain has already received organic damage at an early age and is more vulnerable.

As for those patients who do not have a history of early organic brain damage, the intolerance of neuroleptic drugs in them can trigger a disruption of the water-electrolyte balance and depletion.

[5], [6], [7], [8], [9], [10],

Causes of the neuroleptic Syndrome

NS refers to a group of neurological disorders that develop due to the use of antipsychotic drugs. According to the nature of the manifestation of the National Assembly, they are very multi-form, they are both acute and chronic. At the beginning of the development of the aminazine treatment regimen, brain changes were considered normal phenomena, and many doctors believed that this was a sign of positive dynamics of treatment. However, over time, a deeper study of this phenomenon has revealed a number of very serious and in some cases irreversible psychosomatic changes.

Nevertheless, the most qualitative result of treatment is achieved precisely after the administration of neuroleptics, even if one does not take into account the fact that one third of the cases of Parkinson's disease are provoked by their use. The NA has a negative impact on the person's personality - it becomes antisocial, loses its ability to work, and the quality of life decreases.

There are three stages of manifestation of the disorder - early, prolonged and chronic. By the nature of the symptoms there are the following forms:

• Neuroleptic Parkinsonism;
• acute dystonia;
• akitosia;
• late discenezia;
• malignant neuroleptic syndrome.

Until the end of the cause of neuroleptic syndrome with antipsychotics received and not identified. Among the doctors, a hypothesis has been singled out that the reason for the disorder is that dopamine receptors are blocked, which leads to imbalance of neurotransmitters and termination of the connection between the thalamus and the subcortical structures.

[11], [12], [13], [14], [15]

Risk factors

Neuroleptic syndrome can develop not only from taking antipsychotics, but also for other reasons. Risk factors for neuroleptic syndrome:

Long-term therapy with atypical antipsychotics:

• butyrophenones - haloperidol, domperidone, benperidol;
• phenothiazines - dibenzothiazine, thiodiphenylamine, paradibenzothiazine;
• thioxanthenes - clopixol, truksala, fluansoxol.

Side effects of drugs with antipsychotic treatment:

• high initial doses of neuroleptics;
• treatment with high-grade neuroleptics without a clear dosage;
• injection of antipsychotics;
• treatment of the underlying mental illness with an explicit extrapyramidal disorder;
• too rapid increase in dosage of drugs;
• The introduction of drugs incompatible with neuroleptics.

Fixation in the anamnesis of the characteristic features:

• appointment of est without diagnosis and monitoring of well-being;
• the fact of dehydration of the body;
• the fact of physical exhaustion (inadequate or inadequate nutrition);
• the fact of psychomotor agitation;
• catatonia;
• alcoholism in chronic form;
• violation of water-electrolyte balance;
• dysfunction of the thyroid gland.

The defeat of the brain substance of an organic nature:

• craniocerebral trauma;
• encephalopathy due to trauma;
• dementia;
• persistent extrapyramidal disorder.

[16], [17], [18], [19], [20], [21], [22]

Pathogenesis

The essence of the neurological disorder lies in the weak neuronal conduction around the basal nuclei. The pathogenesis of neuroleptic syndrome in the suppression of dopaminergic neurotransmission, which causes an extrapyramidal disorder, increased muscle tone. As a result, calcium is released, and muscle tissue is gradually destroyed. In parallel, vegetative centers in the hypothalamus are blocked, which leads to loss of control over the heat production and causes a high temperature. Also dopamine blockade of vegetative nuclei leads to hyperkatecholamineemia, hypersympathicotonia, hypercortisoloma. These changes are a deviation from the norm and bear a direct threat to life.

However, treatment with neuroleptics can not always lead to severe neurologic changes. An important role is played by predisposing factors - the scheme and duration of treatment, basic and additional drugs, craniocerebral trauma and the physical condition of the patient.

Antipsychotics are very strong drugs, with prolonged admission, self-medication or an increase in prescribed doses can lead to serious psychosomatic changes, disability and asocialization. Therefore, they should be taken with caution, and the patient should be provided with the necessary assistance and support.

[23], [24]

Symptoms of the neuroleptic Syndrome

At the heart of neuroleptic syndrome is a group of symptoms, noticing that at an early stage you can avoid a serious mental disorder in the future. Key Symptoms of Neuroleptic Syndrome:

• exacerbation of muscle weakness and fever. It can be expressed in a small hypertonic muscle and go up to the impossibility of making a move (symptom "lead pipe").
• the appearance of symptoms from the group of extrapyramidal disorders - the appearance of chorea, dysarthria, bradykinesia, the inability to swallow because of spasm of masticatory muscles, uncontrollable eye movements, "wandering gaze", hyperexpressive facial expressions, increased reflexes, trembling of hands, feet, head, inability to balance, in space, difficult walking.
• high temperature, up to 41-41 degrees, requiring urgent medical intervention.
• somatic abnormalities - the appearance of tachycardia, jumps in blood pressure, blanching of the skin and hyperhidrosis, drooling, enuresis.
• violation of water-electrolyte balance, exhaustion - hollow eyes, dry mucous membrane, flabby skin, plaque on the tongue.
• mental disorders - anxiety, delirium, the appearance of catatonia, the fog of consciousness.

First signs

HC usually does not start dramatically, so the first signs of neuroleptic syndrome will help in time to recognize the onset of the disease, when it can be very quickly and without harm to health to stop.

Bradykinesia - the difficulty of movements becomes noticeable, they are slow, turns are difficult. Movements occur in incomplete volume, stepwise - the symptom of the "cogwheel", the patient can not keep his balance, it becomes difficult to move, the tremor spreads over the head, arms, legs, facial expression is more like a mask, speech is slow or absent, salivation increased. Mental personality changes become more noticeable - depression, lack of sensitivity, bad mood, inhibition of thinking.

This syndrome is formed in the first week of therapy, it is more prone to the elderly.

The phenomena of parkinsonism are especially pronounced in the treatment of neuroleptics with a weak connection (with the appointment of haloperidol, fluorophenazine, trifazin). When treating atypical antipsychotics, the phenomena of parkinsonism are extremely rare.

The drug parkinsonism has a non-long-term nature and passes after the withdrawal of treatment, but sporadic cases are recorded where the symptoms are irreversible and remain for life.

Thus, the first clinical signs of neuroleptic syndrome are as follows:

• Muscle rigidity.
• Hyperthermia (temperature> 38 ° C).
• Sweating.
• Salivation.
• Pale skin.
• Dysphagia.
• Dyspnea.
• Tachypnea, respiratory distress (in 31% of cases).
• Tachycardia.
• Increased or labile blood pressure.
• Hypoxemia.
• Tremor.
• Incontinence of urine and feces.
• Violation of gait.
• Psychomotor agitation.
• Delirium, lethargy, stupor, coma.

[25],

Stages

Reliable causes of extrapyramidal disorders have not been identified, but most experts in the field of psychiatry and neurology adhere to the hypothesis of blockade of dopamine receptors with subsequent destruction of the connection between the thalamus and the subcortical zone. Violations can be triggered by the administration of any neuroleptic drugs, but the most pronounced is after therapy with typical antipsychotic drugs.

The following stages of neuroleptic syndrome are distinguished:

• Formation of neuroleptic Parkinsonism. The movements become intermittent, the person is inactive, the facial muscles are immobile, salivation and sweating appear, it is difficult to concentrate, the ability to memorize and assimilate information decreases, and the interest to the surrounding world is lost.
• The condition of acute dystonia. Occurs either at the beginning of drug therapy, or after increasing the dosage of the main drug. There are involuntary muscular spasms, causing discomfort, and in severe cases leading to dislocation of the joints.
• Early or late forms of akathisia. Increases motor skills, the need for movement, actions. A person feels anxiety, anxiety, constantly touches or tugs clothes. The condition is often burdened by depression, which complicates the course of the initial illness and can even lead to suicide.
• The condition of tardive dyskinesia. Develops after a long period of time from the beginning of treatment, occurs mainly in old age. Muscular spasms, gait distortion, problems of socialization, speech disorders are characteristic.
• Formation of malignant neuroleptic syndrome. ZNS is a quarter of all cases of complications after treatment with neuroleptics. The danger is that even with emergency hospitalization and intensive care, a favorable outcome is not guaranteed and personality changes are irreversible.

[26], [27]

Forms

Depending on the speed of development, it is common to distinguish between acute, chronic and chronic neuroleptic disorder. In acute form, developing at early stages of treatment, there are no serious irreversible changes. To normalize the state, it is sufficient to cancel or reduce the dose of administration of neuroleptics.

Prolonged flow is observed with prolonged therapy with antipsychotic medications, but this condition is more severe, depending on the severity of lesions, treatment under supervision in a hospital environment may be required. Symptomatic passes several months after drug withdrawal.

The chronic form occurs against the background of a fairly long reception of neuroleptics, all changes are irreversible and are not adjusted depending on the tactics of drug treatment.

Symptomatology combining the types of neuroleptic syndrome:

• Lethargy, inhibition, poor orientation in space, problems with movement, muscle spasms and trembling.
• Aemotionality, depressive mood, asociality.
• In malignant course - complete immobility, non-contact, hyperthermia.

NA is a very serious condition, it requires not only competent timely treatment, but also patient care to prevent the development of secondary infection, pressure ulcers, pneumonia and accidental trauma.

Neuroleptic syndrome

As a result of prolonged neuroleptic therapy, a complication that is difficult for a patient's life develops, such as a malignant neuroleptic syndrome. However, he can develop and after taking other drugs that block dopamine receptors. ZNS is a quarter of all cases of complications after treatment with neuroleptics. The danger is that even with emergency hospitalization and intensive care, a favorable outcome is not guaranteed and personality changes are irreversible.

Malignant neuroleptic syndrome is important to be able to differentiate with other diseases in order to have time to help early. The clinic is the most similar to:

• serotonin syndrome;
• lethal catatonia;
• infectious diseases - encephalitis, tetanus, meningitis, rabies, sepsis;
• epileptiform state;
• abstinence (alcoholic, barbiturate, sedative);
• ischemic stroke;
• malignant form of hyperthermia;
• heat shock, overheating;
• poisoning with drugs (amphetamine, salicylates, heavy metal salts, organophosphorus compounds, anticholinergics, strychnine, lithium);
• autoimmune disorders;
• tumors of the central nervous system.

[28], [29], [30]

Extrapyramidal neuroleptic syndrome

Treatment with neuroleptics in the vast majority of cases leads to motor, autonomic and mental disorders. Extrapyramidal neuroleptic syndrome - a combination of symptoms that speak of the defeat of pyramidal structures of the brain. This category includes cases of parkinsonism, dystonia, trembling of the hands, head, chorus akathisia, myoclonic seizures. Motor disorders caused by taking antipsychotics are divided into:

• Parkinsonism. Characteristically uneven flow, mirror lesions, high prolactin levels, sluggish movements, inhibition, loss of balance, wandering gaze, weakness and limitedness in the volume of movements.
• Acute dystonia.
• Acute akathisia. Characterized by anxiety, a constant need for movement, repetitive movements, depressivity, asociality.
• Late dyskinesia.

Extrapyramidal neuroleptic syndrome can be triggered by taking other drugs (calcium antagonists, antidepressants, cholinomimetics, lithium drugs, anticonvulsants). Extrapyramidal disorders require specialized medical care in a hospital environment, without appropriate treatment, a high risk of death.

[31], [32], [33], [34], [35], [36], [37], [38], [39]

Neuroleptic Deficiency Syndrome

Treatment with typical neuroleptics leads to a neuroleptic defect, which is not always reversible after their withdrawal. Neuroleptic deficiency syndrome is characterized by affective disorder, oppression of cognitive and social functions. Symptomatics in many ways is similar to the development of schizophrenia and is divided into primary and secondary. Primary is directly related to the disease, the secondary is associated with a side effect of neuroleptic and is amenable to drug correction.

Neuroleptic deficiency syndrome has the following symptoms:

• Oppression of will power, sluggish lack of initiative, lack of emotional reaction to events. Interest in life is reduced, there is no motivation, habitual interests do not cause any reaction, a person limits the circle of communication and goes into himself.
• The inhibition of motor and mental activity, a decrease in the speed of cogitative activity, the inability to concentrate on the task, the loss of memory, the feeling of "devastation" in the head, as a consequence, and a decrease in intelligence.
• Departure from society, detachment, depressive state, accompanied by sleep disturbance, anxiety, irritability and anger, akathisia. In practice, there are cases when neuroleptic syndrome without proper treatment and care, combined with depression, led a person to commit suicide.

Acute neuroleptic syndrome

Depending on the duration of the disease, it is customary to distinguish between an acute, prolonged and chronic variant of the course of neuroleptic syndrome. Acute neuroleptic syndrome is an early form of the disease that develops during the first days of drug treatment of the underlying disease. At this stage, abrupt withdrawal of the drug leads to the initial state.

The course of the disease is accompanied by a number of symptoms that can not be grouped as unique, which significantly inhibits differential diagnosis. Common signs include slowness of movement, blurred consciousness, impaired thinking, difficulty in moving ("cogwheel"), impaired coordination, trembling of hands, head (parkinsonism). The patient is uncommunicative, does not show emotion, is closed, facial expression is inexpressive. A characteristic feature - hyperkinesis (obsessive, cyclically repetitive movements that can not be stopped by will, only after the introduction of sedatives).

With the continuation of medication, transformation into the most severe form is possible - malignant neuroleptic syndrome. In addition to these neuropsychiatric signs, somatic changes also appear - high temperature (41-42 degrees), complete immobility. If at this stage there is no intensive therapy, then the probability of death is high.

[40], [41], [42]

Complications and consequences

Any drug besides the positive effect has on the body and other effects. This is especially true of neuroleptic drugs. If they take a long period of time or dramatically increase dosage, the following consequences and complications of neuroleptic syndrome develop:

1. All movements are accelerating, a person all the time needs to move, walk, and very quickly. Suspend the motor activity of a person is possible only with the help of sedatives.
2. Another characteristic feature - the constant motor activity of the eyes - a glance, is not fixed for a long time on anything, a pronounced mimic game, a person often shows the language. Along with this, the appearance of hyperlordosis.
3. Affects the facial muscles, which leads to a change in the usual features of the face, this state can remain fixed.
4. Along with physical changes, treatment with neuroleptics is accompanied by depressive conditions.
5. Disorders from the gastrointestinal tract - delayed salivation, heaviness in epigastrium, a feeling of "bursting" in the liver.

With a sharp withdrawal of neuroleptics, there is aggression, pain throughout the body, aches, sleep disturbance, depressive states - the patient is crying, unconcerned. The most dangerous with the abrupt withdrawal of the drug is that there may come a relapse of the underlying disease, which was fought with the help of these drugs. In this situation, you need to address the problem to the treating doctor, so that he reduces the optimal dose of the drug. This will prepare the body to complete the course will not do much harm at the psychosomatic level.

Other potential complications of neuroleptic syndrome:

• Acute necrosis of skeletal muscles.
• Renal failure.
• Cardiac arrhythmias and myocardial infarction.
• Aspiration pneumonia.
• Impaired breathing.
• Pulmonary embolism and deep vein thrombosis.
• Liver failure.
• DIC-syndrome.
• Relapse of psychiatric illness after withdrawal of antipsychotics.

[43], [44], [45], [46], [47]

Diagnostics of the neuroleptic Syndrome

Extrapyramidal syndrome as such has no generally accepted diagnostic criteria, so the diagnosis of neuroleptic syndrome reduces to the exclusion of similar pathological conditions. However, differentiation can be difficult for lethal catatonia, non-hereditary malignant hyperthermia, and serotonin syndrome. For confirmation, an anamnesis is collected, a series of analyzes and functional tests are performed and all necessary studies are prescribed.

[48], [49], [50], [51], [52],

Analyzes

The most informative analyzes with neuroleptic syndrome are based on the study of biologically active body fluids, namely:

• a general blood test (an increase in ESR up to 70 mm / h, a low percentage of white blood cells, a low percentage of protein fractions in the serum sample, urea and creatinine is higher than normal).
• urine for clinical analysis;
• Arterial blood to determine the level of its gases. (high nitrogen content).
• hepatic tests;
• Serum and urine for toxicological examination;
• puncture for the analysis of cerebrospinal fluid, which exclude meningitis, encephalitis, etc .;
• determination of blood clotting rate.

If significant deviations from the norm are recorded in the analyzes, instrumental and differential diagnosis excludes other diseases, the patient with neuroleptic syndrome requires hospitalization and further treatment. Depending on the form and stage of the disease, we can talk about a further prognosis regarding the patient's health.

[53], [54], [55], [56], [57], [58], [59]

Instrumental diagnostics

The most informative laboratory analyzes include research of biologically active liquid media of the organism, namely:

• conducting a general blood test;
• urine for clinical analysis;
• Arterial blood to determine the level of its gas content;
• hepatic tests;
• Serum and urine for toxicological screening;
• puncture for the analysis of cerebrospinal fluid;
• determination of blood clotting rate.

Instrumental diagnosis of neuroleptic syndrome occurs in two stages:

• organization of lung radiography;
• purpose electroencephalography for monitoring the electrical conductivity of impulses in the brain.

Based on the results of the analyzes at the National Assembly, the following data are indicated:

• the detection of leukocytosis, the shift of the formula to the left;
• high creatinophosphokinase;
• confirmation of metabolic acidosis.

The malignant course of neuroleptic syndrome is indicated by imbalance of electrolytes, high alanine aminotransferase, aspartate aminotransferase, aldolase, lactate dehydrogenase or lactic acid, low serum iron, high nitrogen content in the blood, decomposition of muscle protein and its appearance in the urine.

Differential diagnosis

Recognize the neuroleptic syndrome at an early stage is quite difficult, mainly due to the fact that its symptoms are attributed to the underlying disease. It is dangerous to skip the first symptoms also because the delayed differential diagnosis of neuroleptic syndrome leads to its malignancy, which worsens the patient's psychosomatic state and can be irreversible.

It is difficult to establish the diagnosis and differentiate this state and because of the extensive choice of similar conditions. On inspection, it is necessary to exclude the fact:

• benign neuroleptic extrapyramidal syndrome (proceeds without a rise in temperature);
• loss of clarity of consciousness, rhabdomyolysis processes);
• catatonic state (it is necessary to specify the data when collecting anamnesis);
• meningitis;
• encephalitis;
• hemorrhage in the subcortex of the brain (confirmed after a lumbar puncture);
• thermal shock (skin integuments dry, and muscles, in comparison with NS, in the hypotone);
• exclude the possibility of malignant hyperthermia (in the anamnesis may be anesthesia with the use of halogenated anesthetic, injection of succinylcholine);
• non-convulsive epilepsy;
• fevers of infectious etiology;
• serotonin syndrome (in the anamnesis taking antidepressants, diarrhea, nausea, but there is no pronounced muscular depletion);
• poisoning (amphetamines, cocaine, alcohol, barbiturates).

Treatment of the neuroleptic Syndrome

Medical tactics in the emergence of neuroleptic syndrome in patients requires as soon as possible the abolition of the basic neuroleptic, followed by a phased restoration of all functions. Treatment of neuroleptic syndrome is as follows:

• The introduction of an antipsychotic or other drugs that led to a disorder (lithium, antidepressants, setrons) is stopped.
• Termination of the introduction of drugs, aggravating the manifestations of rhabdomyolysis.
• Removal of drug residues, detoxification - rinsing of the stomach cavity, intestines, introduction of enterosorbent, administration of diuretics and according to indications, plasma purification is carried out.
• Dantrolene is prescribed, a drug that blocks the release of calcium from muscle cells, eliminating muscle tension, normalizing temperature and blocking the growth of rhabdomyolysis.
• Conducting the procedure of electroconvulsive therapy.
• The introduction of dopamine antagonists and its corrective drugs - amantadine, bromocriptine. Necessarily the appointment of cyclodol, midocalam, baclofen. To reduce muscle tone.
• For the release of dopamine - dexamethasone, methylpredisylone.
• Restoration of water-electrolyte balance. Controlling the level of electrolytes, sugar, preventive measures against the work of the kidneys.
• Prevention of the development of gastric ulcer - the introduction of ranitidine, omeprazole.
• Prevention of thrombus formation.
• Normalization of body temperature, antiretics, lytic mixture, cold on large arteries.
• Continuous care for the patient - prevention of decubitus, pneumonia.

Delusional state after taking cyclodol, bomocriptine represent a minimal danger and easily blocked by sedatives, and hyperthermia, muscle spasms and immobility pose a direct threat to life.

Emergency Care for Neuroleptic Syndrome

Neuroleptic syndrome can be called a negative consequence of treatment with antipsychotics. Emergency care for neuroleptic syndrome is aimed at eliminating life-threatening symptoms. Symptom is manifested in three areas:

1. Vegetative. The appearance of tachycardia, lowering of pressure, sweating, drooling, urinary incontinence, skin pallor, photosensitivity, lethargy and general weakness.
2. Neurological. Increased tone of smooth muscles, reduced the flexibility of the limbs as a "cogwheel", cramps, trembling of the hands, legs, head, hyperdrive. The muscles of the facial skull and facial motionless ("masculinity"), the appearance of the syndrome Kulenkampff-Taranova (spasms of swallowing muscles combined with the need to protrude the tongue).
3. Mental. The emergence of anxiety, internal anxiety, hypermobility, molestation, trouble with sleep.

The most dangerous condition in the treatment with neuroleptics is a malignant neuroleptic syndrome. It is characterized by critical hyperthermia, vegetative disorders, development of the toxic form of dermatitis.

Emergency care for neuroleptic syndrome is as follows:

1. Complete abolition of neuroleptics and hospitalization in the intensive care unit.
2. The introduction of antipyretic drugs.
3. Combating dehydration and disturbance of water-electrolyte balance.
4. Amantadines intravenously, after stabilization of the condition - orally.
5. Benzodiazepines intravenously.
6. Improvement of blood microcirculation.
7. In case of problems with breathing - artificial ventilation.
8. Sensing the stomach through the nasal cavity - for nutrition and hydration.
9. Heparin to improve blood flow.
10. Preventive measures to prevent secondary infection.
11. If necessary, electroconvulsive therapy.

[60], [61], [62], [63], [64]

Medicinal treatment

Extrapyramidal disorders, like other psychosomatic disorders, require urgent medical correction. Medicines for neuroleptic syndrome are prescribed depending on the form and stage, so the dosage of the basic drugs can be adjusted by the doctor.

In dyskinesia, to facilitate the condition, prescribe akineton in a dosage of 5 mg, in its absence - aminazine, 25-50 mg injection + 2% caffeine solution under the skin. Akineton can not be prescribed with levodopa - this aggravates the dyskinetic disorder, with the intake of alcohol, the CNS is depressed. Aminazine can not be prescribed for cirrhosis, hepatitis, myxedema, kidney failure, heart defects, thromboembolism, rheumatism, arthritis, as well as alcohol, barbiturate, narcotic intoxication.

In the extrapyramidal syndrome, antiparkinsonian correctors are administered at an acute stage - cyclodol from 6 to 12 mg, akinetone, injection of treblex (administered only in combination with fluspirilene with one injection) to arrest muscle spasms and normalize motor activity. Cyclodol should be prescribed under the constant supervision of a doctor, since in a large dosage it can provoke delusions and vomiting.

Along with medicamental treatment, positive dynamics is achieved when performing plasma purification, which completely eliminates extrapyramidal disorder in 2-3 procedures, the manifestation of akinesia, hypertension of muscles, tremor, hyperkinesia is weakened. Passes depressive state, melancholy, emotional state is normalized.

Prevention

The use of neuroleptic drugs should take place under the supervision of the attending physician, with strict adherence to the doses and timing of admission. Prevention of neuroleptic syndrome is to monitor the physical and mental condition of the patient and control of his vital functions.

If, however, a psychiatric disorder for which antipsychotics is prescribed requires continuation of therapy after the fact of a neuroleptic syndrome in any form, then a second course can be resumed only after the symptoms of the ZNS are eliminated.

In addition, a repeated course of neuroleptic drugs is carried out only under clinical control in a hospital setting. This is vital, as it will help prevent the recurrence of neuroleptic syndrome and avoid life-threatening complications.

Neuroleptics - a very strong group of drugs, uncontrolled use and self-medication can lead not only to the oppression of the brain, the violation of clarity of consciousness and social closure, but also to death.

[65], [66], [67], [68], [69], [70]

Forecast

Prolonged use of antipsychotics is often the cause of complications. The prognosis of neuroleptic syndrome is further complicated by the fact that in most cases a secondary form of the disease develops, which is characterized by a severe course and a predominance of neurological disorders. This leads to a malignant course of the disease and can lead to death.

Among pathologies developing on the basis of secondary and malignant neuroleptic syndrome, cases of rhabdomyolysis (depletion of muscle fibers and tissue atrophy), functional respiratory disorders-cases of pulmonary embolism, aspiration pneumonia, pulmonary edema, respiratory distress syndrome are documented. Also affects the digestive system (the development of liver failure), cardiovascular (violation of rhythm, electrical conductivity of the heart until it stops), multi-infection of the body (blood infection, infectious diseases of the genitourinary system), damage to the nervous system - the development of cerebral insufficiency.

Without proper treatment, the primary fact of HC is transformed into a more severe form of flow, but even with proper treatment, relapses are not excluded. Therefore, the disease requires strict adherence to medical prescriptions and additional care for a person.

At present, mortality from neuroleptic syndrome is estimated at 5-11.6%. Mortality is caused by one or more complications (eg, respiratory failure, cardiovascular collapse, renal failure, arrhythmias, thromboembolism, DVS). Renal failure is the cause of death in 50% of cases.

[71],