神经阻滞剂恶性综合征
小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 意识状态改变
- 肌肉强直
- 自主神经功能障碍
- 体温过高
- 精神病史
其他诊断因素
- 铁缺乏史
- Wilson 病史
危险因素
- 暴露于抗精神病药物
- 突然停用多巴胺能药物
- 脑结构异常
- 老年
- 已患有激越
- 静坐不能
- 男性
- 铁缺乏症
- 紧张症
- 已患有脱水
- 多巴胺拮抗剂和其他抗精神病药暴露
诊断性检查
首要检查
- 全血细胞计数（FBC）
- 血清肌酸激酶
- 基础代谢检查
- 头颅 CT 扫描
- 脑部 MRI
- 肌红蛋白水平和尿液分析
- 尿液培养
- 血液培养
- 腰椎穿刺：
- 毒理学筛查
- 胸部 X 线检查
需考虑的检查
- 血清铁
- 脑电图 (EEG)
治疗流程
首次发作
复发
撰稿人
作者
Ronald J. Gurrera, MD
Associate Professor
Harvard Medical School
Boston
MA
利益声明
RJG is a member of the Neuroleptic Malignant Syndrome Professional Advisory Board, and has given expert testimony in medical malpractice tort claims in which NMS was alleged. He is an author of several references cited in this topic.
鸣谢
Dr Ronald J. Gurrera would like to gratefully acknowledge Dr Peter F. Buckley, a previous contributor to this topic. PFB is on the advisory board (a voluntary, uncompensated role) of the Neuroleptic Malignant Syndrome Information Service. He is also a consultant to Janssen Pharmaceutica and the National Institute of Mental Health (NIMH). He is conducting or has recently conducted research with funding support from AstraZeneca, NIMH, Janssen Pharmaceutica, Pfizer, Solvay, and Wyeth. Previous consultancy and research support has been from Abbott, Alamo Pharmaceuticals, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Lundbeck, Janssen Pharmaceutica, Merck, NIMH, Roche Diagnostics, Pfizer, Solvay, and Wyeth. PFB has no patents or stock in any company. He is an author of several references cited in this topic. PFB is a co-investigator on a study also involving Dr John Lauriello and Dr Daniel R. Wilson, who were reviewers for this topic.
同行评议者
Alison Haddow, MBBS
Consultant Psychiatrist
Honorary Senior Clinical Lecturer
Royal Cornhill Hospital
Aberdeen
UK
利益声明
AH declares that she has no competing interests.
John Lauriello, MD
Professor and Chair
Department of Psychiatry
University of Missouri-Columbia
Columbia
MO
利益声明
JL declares that he has no competing interests.
Ganesh Gopalakrishna, MD
Assistant Professor
Department of Psychiatry
University of Missouri-Columbia
Columbia
MO
利益声明
GG declares that he has no competing interests.
鉴别诊断
- 脓毒症
- 药物滥用
- 紧张症
更多 鉴别诊断指南
- 成人帕金森病
- 儿童急性心理健康或行为问题的评估和管理。第二部分：识别存在医学或不明症状的临床挑战性心理健康相关疾病
更多 指南患者教育信息
神经阻滞剂恶性综合征
更多 患者教育信息
登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容
内容使用需遵循免责声明