Hi XXXXX
Thanks for writing in.

As mentioned, your present medication includes:
1. Madopar: levodopa and benserazide
2. Lithium
3. Endep: amitriptyline (tricyclic antidepressant)
4. Betaloc: metoprolol (betablocker)
5. Nexium: esmoprazole (protonpump inhibitor)
6. Coversyl: perindopril (ACE inhibitor)

Neuroleptic Malignant Syndrome (NMS), is usually seen with antipsychotics or major tranqulizers. It is a very rarely encountered syndrome but is very serious. There are a few factors that may increase the risk of developing NMS which include:
Concurrent medical and neuropsychiatric issues
Dehydration
Low serum iron levels
Mood disorders
History of NMS
Acute parenteral antipsychotics
High potency first generation antipsychotics (e.g., haloperidol)
Concurrent lithium treatment
High doses of an antipsychotic
Young males

Nonetheless the presence of these factors only means being alert and does not mean will necessarily cause NMS in a patient.

In your current medications there is no risk. Risk exists with antipsychotics.
Early identification is possible if you are aware of the symptoms and it is treatable by withdrawing the offending agent immediately.
Dehydration is a common treatable cause of NMS.

Typical symptoms include :
Muscle rigidity and elevated temperature (greater than 38°C)
Sweating, tachycardia, fluctuating blood pressure
Dysphagia, incontinence
Tremor
Confusion

Please report to your doctor if you feel that you have any adverse symptoms.

Hope your queries are answered.
Should there be any further queries, please feel free to write back.

Wishing you good health

Regards
Dr A Rao Kavoor

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Hi,

Thanks for writing back,

I understand that you are concerned.

Other than noting the presence of risk factors and being cautious, it is not possible to predict the development of the syndrome in a patient so it is not possible to say if it is safe to be discharged right away after antipsychotics are started. If you are put on antipsychotics, you can be supervised for a few weeks (depending on the doctor’s judgment) and then discharged on the drugs. Giving oral antipsychotics as opposed to parenteral and low dose second generation antipsychotics as opposed to first generation or high dose antipsychotics can reduce the risk further. In a case of BPAD, antipsychotics are necessary only in the acute phase and can be reduced slowly and withdrawn later once patient is in remission so it need not be continued for long. You may also keep in mind that abruptly stopping the levodopa that you are currently on can lead to NMS so be in touch with a psychiatrist even after discharge.

In a psychiatry hospital, you will need to provide exact treatment details and further treatment can include antipsychotics under surveillance. Signs of NMS are always given importance in any psychiatry hospital and measures taken to treat it. Doctors in a psychiatry hospital will be well aware of your medications. The admission details like criteria of admitting, length of stay and cost etc. may differ depending on the country or location. But generally patients who need medical attention or frequent investigations are admitted and kept under observation till he/she is safe to be discharged. Your discharge will usually depend on the reason for admission.

I hope this answers your question,
In case of any queries do write back,
Dr. A. Rao. Kavoor.

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