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Neuroleptic malignant syndrome: a case responding to electroconvulsive therapy plus bupropion

Quintí Foguet-Boreu, Montse Coll-Negre, Montse Serra-Millàs, Miquel Cavalleria-Verdaguer
  • Quintí Foguet-Boreu http://orcid.org/0000-0002-6069-5305
    Department of Psychiatry, Vic University Hospital, Vic, Spain; Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain | 42292qfb@comb.cat
  • Montse Coll-Negre
    Department of Psychiatry, Vic University Hospital, Vic, Spain
  • Montse Serra-Millàs
    Department of Psychiatry, Vic University Hospital, Vic; Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain
  • Miquel Cavalleria-Verdaguer
    Department of Psychiatry, Vic University Hospital, Vic, Spain

Abstract

Neuroleptic malignant syndrome (NMS) is a severe motor syndrome occurring as a consequence of neuroleptic treatment. We present a case of a 67-year-old Caucasian woman with a history of a major depressive disorder with psychotic features. During her third hospital admission, symptoms of autonomic instability, hyperpyrexia, severe extrapyramidal side effects, and delirium appeared, suggesting NMS due to concomitant treatment with risperidone and quetiapine, among other drugs. Despite several consecutive pharmacological treatments (lorazepam, bromocriptine and amantadine) and prompt initiation of electroconvulsive therapy (ECT), clinical improvement was observed only after combining bupropion with ECT. The symptoms that had motivated the admission gradually remitted and the patient was discharged home. Bupropion increases dopaminergic activity in both the nucleus accumbens and the prefrontal cortex. Therefore, from a physiopathological standpoint, bupropion has a potential role in treating NMS. However, there is scarce evidence supporting this approach and therefore future cases should be carefully considered.

Keywords

Case report; neuroleptic malignant syndrome; major depressive disorder; electroconvulsive therapy; bupropion.

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Submitted: 2017-11-28 09:02:28
Published: 2018-01-26 14:45:26
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