گزارش يك مورد سندرم نورولپتيك بدخيم آتيپيك

A CASE REPORT OF ATYPIC NEUROLEPTIC MALIGNANT SYNDROME

Background & Aim: Neuroleptic malignant syndrome is a rare but life threatening complication of dopamin receptor antagonist drugs. The mortality rate can be higher when a depot form of dopamin receptor antagonist is used. The major symptoms which occur after neuroleptic treatment include muscular rigidity, hyperthermia, sweating, dysphagia, tremor, urianary incontinence, changes in level of consciousness ranging from confusion to coma, mutism , tachycardia, elevated or fluctuated blood pressure, leukocytosis and laboratory evidance of muscle injury (eg, elevated creatine phosphokinase). In this case report, we present a neuroleptic malignant syndrome without hyperthermia. History: The patient was a lady of 28 years old diagnosed as a major depressive disorder and was under medical treatment. Because of appearance of psychotic symptoms in the last episode, fluphenazine decanoate had been injected injudiciously. After few hours neuroleptic malignant syndrome developed, but no rise in body temperature was observed during the course of disease. Patient was admitted in psychiatric Center Hospital-Urmia and after 3 weeks was transferred to ICU of Imam Khomeini Hospital-Urmia. Gradually the symptoms disappeared and she was discharged from hospital. Discussion: According to the fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), hyperthermia is a necessary criterion for neuroleptic malignant syndrome. So far it is expected that American Psychiatric Association consider more flexibility for the diagnostic criteria of neuroleptic malignant syndrome in the next edition of DSM.