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There is more to this fever than meets the eye: A case of neuroleptic malignant-like syndrome (NMLS) secondary to withdrawal of procyclidine and L-dopa on a background of long-standing flupenthixol depot use

Published online by Cambridge University Press:  08 April 2020

S. Waqas Open the ORCID record for S. Waqas [Opens in a new window] ,
M. Talty ,
S. O’Keeffe ,
J. Flood  and
A. M. Doherty
S. Waqas*
Affiliation:
Infectious Diseases Department, St. Vincent’s University Hospital, Dublin, Republic of Ireland Infectious Diseases Department, University College Hospital, Galway, Republic of Ireland
M. Talty
Affiliation:
Rheumatology Department, University College Hospital, Galway, Republic of Ireland
S. O’Keeffe
Affiliation:
Geriatric Medicine Department, University College Hospital, Galway, Republic of Ireland
J. Flood
Affiliation:
Rheumatology Department, University College Hospital, Galway, Republic of Ireland
A. M. Doherty
Affiliation:
Psychiatry Department, University College Hospital, Galway, Republic of Ireland
*
*Address for correspondence: Dr. Sarmad Waqas. Locum Consultant Physician, Infectious Diseases and General Medicine, St. Vincent’s University Hospital, Elm Park, Dublin 4, D04 T6F4, Republic of Ireland (Email: sarmadwaqas@svhg.ie)
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Abstract

This case report highlights the risk of development of Neuroleptic Malignant-Like Syndrome secondary to withdrawal of procyclidine with brief withdrawal of L-dopa and long-term typical antipsychotic depot. The patient responded to reintroduction of procyclidine, sedation and supportive treatment. The mechanism and management of NMS and NMLS is also reviewed. This case emphasises that any changes in antipsychotic and antiparkinsonian medications should be undertaken with extreme caution and patient should be closely monitored for development of NMLS after alteration in these medications.

Type
Case Report
Information
Irish Journal of Psychological Medicine , Volume 40 , Issue 2 , June 2023 , pp. 288 - 291
Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of The College of Psychiatrists of Ireland

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