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Background: Paliperidone is a second-generation antipsychotic and the main active metabolite of risperidone, formulated to provide consistent therapeutic effects through an extended-release system, designed to provide consistent therapeutic effects through an extended-release formulation. While commonly used in clinical practice, switching from risperidone to paliperidone, particularly during valproate therapy, can pose challenges due to potential pharmacokinetic interactions that may increase the risk of extrapyramidal symptoms (EPS). Despite clinical observations suggesting these interactions, case reports documenting such adverse effects are scarce. Case presentation. We report a case of a 48-year-old Japanese male with epilepsy-associated psychosis and mild intellectual disability who experienced severe EPS during a gradual cross-titration from risperidone to paliperidone while on valproate therapy. The patient had a history of well-controlled epilepsy with valproate and developed auditory hallucinations, delusions, and psychomotor agitation at age 48. Initial treatment with risperidone was partially effective but did not sufficiently manage his psychotic symptoms, prompting a switch to paliperidone. Shortly after increasing the paliperidone dose, the patient developed significant EPS, including muscle rigidity and elevated creatine kinase levels, indicative of potential neuroleptic malignant syndrome. Paliperidone was immediately discontinued, leading to a marked improvement in symptoms. Discussion: This case highlights the pharmacokinetic interaction between valproate and paliperidone, which can elevate plasma levels of paliperidone and exacerbate EPS. Literature suggests that valproate can prolong the gastrointestinal retention time of paliperidone, leading to increased absorption and enhanced dopaminergic blockade. The gradual cross-titration method may have compounded these effects, emphasizing the need for careful dose adjustments and monitoring during antipsychotic switching, especially in patients on concomitant valproate therapy. Conclusion: The findings suggest that direct substitution methods, rather than gradual cross-titration, may be safer when switching from risperidone to paliperidone, particularly in patients receiving valproate. Clinicians should be aware of the potential interactions and closely monitor for signs of EPS during such therapy adjustments. [ABSTRACT FROM AUTHOR]

Background: Foreign language syndrome is a rare neuropsychiatric phenomenon typically following general anesthesia. To date, foreign language syndrome has not been associated with neuroleptic malignant syndrome (NMS) in the literature. This case aims to broaden the clinical understanding of NMS by presenting an atypical manifestation of foreign language syndrome and emphasizing the need for prompt recognition of such presentations for accurate diagnosis and management. Case presentation: A 34-year-old Caucasian male with a history of schizoaffective disorder and recurrent psychiatric hospitalizations was admitted for a depressive episode. His condition worsened hours after the administration of intramuscular chlorpromazine, leading to NMS characterized by agitation, muscle rigidity, hyperthermia, autonomic instability, abnormal laboratory findings, and altered mental status, including foreign language syndrome. Management included the discontinuation of the prior psychopharmacotherapy, intravenous hydration, and medications (biperiden, lorazepam). The patient showed significant improvement, with resolution of NMS symptoms and normalized sleep patterns by the time of discharge. Conclusion: Foreign language syndrome is an exceptionally rare occurrence, with only nine documented cases to date, all involving male patients. This case presents a novel instance of foreign language syndrome in the context of NMS in a male patient, providing insight into the potential sex-specific mechanisms underlying this rare phenomenon. This case adds valuable evidence to the understanding of the clinical spectrum of NMS and highlights the importance of recognizing atypical presentations in managing patients with neuropsychiatric conditions. [ABSTRACT FROM AUTHOR]

Background: Neuroleptic malignant syndrome (NMS) is a rare but potentially life-threatening adverse drug reaction. This study aims to identify the most prevalent drugs associated with the risk of NMS according to the United States Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database. Methods: Analyses were performed using data from the FAERS database from January 2004 to June 2024. Single-drug signals were evaluated using the reporting odds ratio (ROR), proportional reporting ratio (PRR), information component (IC), and empirical Bayes geometric mean (EBGM). Meanwhile, comparisons were performed with drug labels. Additionally, subgroup analysis was conducted, focusing on adverse drug reaction signals among populations of different genders and age groups. Results: A total of 10,433 adverse event reports related to NMS were identified, with the top 50 drugs ranked by ROR mainly involving antipsychotics (18, 36%), antiparkinson drugs (10, 20%), antidepressants (7, 14%), antiepileptics (3, 6%), anxiolytics (3, 6%), as well as hypnotics and sedatives (3, 6%). NMS is more prevalent in males (5,713, 54.76%). Among the top 20 drugs with the strongest signal strength, the pediatric group showed an additional presence of benzodiazepines and antiepileptic drugs compared to the adult group. Conclusion: The current comprehensive pharmacovigilance study identified more drugs associated with NMS and provides references to clinicians for clinical practice. Also, further research is needed to investigate the causal relationship between these drugs and NMS. [ABSTRACT FROM AUTHOR]

Background: Creatine kinase (CK) is an intracellular enzyme expressed most commonly in tissues such as skeletal muscle. CK can be used as an investigation to support the diagnosis of conditions such as neuroleptic malignant syndrome (NMS), a rare idiosyncratic drug reaction – classically to antipsychotic medications – which can be fatal. Routine screening of CK in psychiatric inpatients is a known practice, but its value is uncertain. We aimed to ascertain whether such screening resulted in new diagnoses of NMS or other conditions, and changes in clinical management. Methods: Using an electronic case register, we conducted a descriptive retrospective cohort study, identifying all psychiatric inpatient admissions in a South London mental health trust over a four-year period where a CK test was conducted within 48 h of admission. We extracted the demographic and clinical characteristics (e.g., diagnosis) of those who met inclusion criteria. Free-text review was performed on all those with a CK potentially suggestive of NMS (CK ≥ 4x upper limit of normal reference range (ULN)) to determine the impact of this abnormal result on subsequent management and diagnosis (including NMS if identified). Results: Of 14,236 inpatient episodes in the specified window, 2358 (16.6%) had a CK test within 48 h of admission. This was ≥ 4x ULN in 327 (13.8%) cases (free-text successfully reviewed in 318). There were no cases of NMS identified. An abnormal CK result led to a new alternative diagnosis, such as dehydration or catatonia, in only 14 patients (4.4% raised CK sample, 0.6% total CK sample). Impact on subsequent management appeared limited, with the most common adjustment being an increase in frequency of physical observations in 47 instances (14.8%). Conclusions: The clinical utility of untargeted screening using a serum CK for psychiatric inpatients appears limited, with poor specificity in detection of NMS and a minimal impact on subsequent clinical management. [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Malignant hyperthermia (MH) and anesthesia-induced rhabdomyolysis (AIR) are rare, yet life-threatening complications that need prompt therapeutic actions and logistic preparedness for treatment success. Both conditions are triggered by general anesthetics, particularly volatiles and depolarizing muscle relaxants. In comparison with MH, which is an inherited pharmacogenomic disease of calcium channel receptor subpopulation and arises only after trigger exposure, AIR has been described mostly in patients with muscular dystrophies. In perioperative settings, rhabdomyolysis is also observed during propofol infusion syndrome, neuroleptic malignant syndrome, and cocaine, heroin, and alcohol intoxication. Despite their diverse etiology, the main clinical manifestations of MH and AIR overlap: a hypermetabolic state, hyperpyrexia, hypercarbia, acute renal failure, and hyperkalemia progressing to cardiac arrest, making the therapeutic approach to the patient extremely difficult. Case Report: We present an unenviable and challenging clinical scenario of an obligatory general anesthesia with endotracheal intubation in a patient with difficult airways for breast conserving onco-surgery with simultaneous targeted intraoperative 20 Gy irradiation. The case was complicated even further by coincident suspicious clinical presentation of a mild and self-limited hypercarbia, together with a protracted rhabdomyolysis, without hyperpyrexia. Given the atypical and scarce clinical presentation leading to diagnosis uncertainty of MH or AIR, which was proved only after receiving the genetic results, dantrolene was not administered, and the patient underwent successful supportive treatment. Conclusions: The study points to the diagnostic dilemma - crisis event MH or AIR - and raises issues about possible preoperative preventive measures and treatment options in patients with an uncertain diagnosis. [ABSTRACT FROM AUTHOR]

Psychopharmacs belong to the most frequently prescribed drugs not only by psychiatrists but also, by other specialists. Acute psychopharmacs-associated conditions can occur during their initial or later phase of treatment and at their, mostly sudden, discontinuation. They need usually an immediate treatment intervention. In this paper we focus on acute conditions occurring with the treatment and discontinuation of antipsychotics and antidepressants. [ABSTRACT FROM AUTHOR]

Background and Purpose: Despite the wide use of dopamine receptor blocking agents (DRBAs) in Huntington disease (HD), neuroleptic malignant syndrome (NMS) is rarely described in this population. The aim of this study was to assess NMS prevalence in a large cohort of HD patients and explore the main associated risk factors. Methods: In 2023, an HD patient was admitted to our neurology department due to NMS. Starting from the case description, we performed a narrative review of the literature of NMS cases in HD, reviewed data from the fifth dataset of the Enroll‐HD (a longitudinal, observational, global study of families with HD) study (PDS5) selecting HD patients treated with DRBAs and/or tetrabenazine (TBZ) who presented at least one of the core symptoms of NMS (rigidity and hyperthermia), and collected data to investigate prevalence of NMS and identify risk factors. Results: In the Enroll‐HD PDS5 dataset, we identified 5108 of 11,569 HD patients who were undergoing DRBA and/or TBZ treatment. Only one patient, a Caucasian man of 46 years, undergoing clozapine and valproate treatment, had a registered diagnosis of NMS. Conclusions: NMS in HD patients is seldom described. This could be due to an underestimation of this condition. There are no available objective NMS diagnostic criteria at present, and the existence of atypical forms of NMS further complicates diagnosis. Advanced disease stage, rigid–akinetic phenotype, abrupt therapy changes, polytherapy, and dehydration are key risk factors, most of which are preventable through awareness and caution in managing medications in the HD population. [ABSTRACT FROM AUTHOR]

Consultation liaison psychiatrists are frequently asked to evaluate patients with altered mental status (AMS). Psychiatrists have unique perspectives and approaches to care for confused patients, particularly optimizing facilitation of care and maintaining vigilance for diagnostic overshadowing. Psychiatrists also offer expertise in primary psychiatric illnesses that can overlap with AMS, and the most common etiology of AMS is delirium. In this article, we provide a consultation liaison psychiatrist perspective on AMS and related psychiatric conditions in addition to delirium. Manic and psychotic episodes have primary and secondary etiologies, with some symptoms that can overlap with delirium. Catatonia, neuroleptic malignant syndrome, and serotonin syndrome are potentially fatal emergencies, and require prompt index of suspicion to optimize clinical outcomes. Trauma sequelae, functional neurologic disorders, and dissociative disorders can present as puzzling cases that require psychiatric facilitation of care. Additionally, AMS is sometimes due to substance intoxication and withdrawal in the hospital. A nonstigmatizing approach to evaluation and management of delirium and AMS can ensure optimal patient care experiences and outcomes. [ABSTRACT FROM AUTHOR]

Background: Real-world evidence supporting a safe and effective transition from rituximab originator (RTX-O) to its biosimilars (RTX-B) in autoimmune rheumatic diseases (ARDs) is still limited. Objectives: The primary aims of this study were to evaluate the long-term persistence of RTX-B after the non-medical switch (NMS) from RTX-O in ARD patients, and to explore the RTX-B safety profile. The secondary aims were to evaluate the impact of different factors on RTX-B drug retention rate (DRR) and to identify any factors associated with RTX-B discontinuation. Design: Retrospective observational study. Methods: We included consecutive ARD patients undergoing NMS from RTX-O to GP2013 or CT-P10 from January 2018 to December 2020. RTX-B DRR was estimated by Kaplan–Meier plot analysis and compared according to different factors by the Log-rank test; the Cox proportional hazard model was used to detect factors associated with RTX-B discontinuation in the first 36 months. Results: We enrolled 181 patients switching to RTX-B: GP2013 in 143 (79.0%) cases and CT-P10 in 38 (21.0%). The estimated DRR for RTX-B was 81.5% at 12 months, 80.6% at 24 months, and 77.4% at 36 months. The incidence of adverse events with RTX-B was 12.6/100 patients/year. In the Log-rank test, no statistically significant differences were observed in the RTX-B DRR according to sex (p = 0.171), ARD diagnosis (p = 0.281), and concomitant immunosuppressive therapy (p = 0.054); on the contrary, patients on GP2013 showed a higher DRR than those on CT-P10 (p < 0.001). In the Cox proportional hazard analysis, the switch to CT-P10 was associated with a higher probability of stopping treatment (hazard ratio, 1.83 (confidence interval, 1.10–3.04), p = 0.02). Conclusion: NMS to RTX-B is associated with a high chance of retaining the drug for up to 36 months, irrespective of the diagnosis. GP2013 showed a higher retention rate than CT-P10. [ABSTRACT FROM AUTHOR]

The document is a comprehensive guideline for the pharmacological treatment of schizophrenia, developed by the Japanese Society of Neuropsychopharmacology and the Japanese Society of Clinical Neuropsychopharmacology. It emphasizes the importance of a holistic approach to treatment, combining psychosocial interventions with medication. The guideline includes diagnostic criteria, differential diagnoses, and treatment recommendations for different stages of schizophrenia. It also highlights the significance of shared decision-making between healthcare providers and patients, as well as the use of evidence-based practices in clinical settings. The document addresses the differentiation of schizophrenia from other disorders and stresses the importance of accurate diagnosis and treatment strategies. [Extracted from the article]

The editorial titled "How does brain stimulation work? Neuroversion and other putative mechanisms of action" explores the evolving field of brain stimulation techniques in psychiatry and neurology. It discusses various methods such as electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and deep brain stimulation (DBS) that trigger neurochemical and electrophysiological changes in the brain to produce therapeutic effects. The research topic includes 10 articles authored by 76 individuals covering a range of brain stimulation techniques and their applications in neuropsychiatric disorders, aiming to enhance understanding and influence further research and clinical practice. The findings presented in the editorial highlight the diverse applications of brain stimulation techniques and their potential benefits, contributing to the advancement of clinical practice and stimulating further investigation into the mechanisms underlying these therapies. [Extracted from the article]

Objective: The incidence of neuroleptic malignant syndrome (NMS), a rare, potentially fatal adverse effect of antipsychotics, among children and youth is unknown. This cohort study estimated NMS incidence in antipsychotic users age 5–24 years and described its variation according to patient and antipsychotic characteristics. Methods: We used national Medicaid data (2004–2013) to identify patients beginning antipsychotic treatment and calculated the incidence of NMS during antipsychotic current use. Adjusted hazard ratios (HRs) assessed the independent contribution of patient and antipsychotic characteristics to NMS risk. Results: The 1,032,084 patients had 131 NMS cases during 1,472,558 person-years of antipsychotic current use, or 8.9 per 100,000 person-years. The following five factors independently predicted increased incidence: age 18–24 years (HR [95% CI] = 2.45 [1.65–3.63]), schizophrenia spectrum and other psychotic disorders (HR = 5.86 [3.16–10.88]), neurodevelopmental disorders (HR = 7.11 [4.02–12.56]), antipsychotic dose >200mg chlorpromazine-equivalents (HR = 1.71 [1.15–2.54]), and first-generation antipsychotics (HR = 4.32 [2.74–6.82]). NMS incidence per 100,000 person-years increased from 1.8 (1.1–3.0) for those with none of these factors to 198.1 (132.8–295.6) for those with 4 or 5 factors. Findings were essentially unchanged in sensitivity analyses that restricted the study data to second-generation antipsychotics, children age 5–17 years, and the 5 most recent calendar years. Conclusion: In children and youth treated with antipsychotics, five factors independently identified patients with increased NMS incidence: age 18–24 years, schizophrenia spectrum and other psychotic disorders, neurodevelopmental disorders, first-generation drugs, and antipsychotic doses greater than 200 mg chlorpromazine-equivalents. Patients with 4 or 5 of these factors had more than 100 times the incidence of those with none. These findings could improve early identification of children and youth with elevated NMS risk, potentially leading to earlier detection and improved outcomes. [ABSTRACT FROM AUTHOR]

The editorial discusses Neuroleptic Malignant Syndrome (NMS) in children and adolescents treated with antipsychotics, highlighting the core symptoms, risk factors, and potential lethality of NMS. It emphasizes the need for population-level studies to understand the occurrence, risk factors, and course of NMS in young patients. A recent study by Ray and colleagues analyzed data from a large cohort of Medicaid beneficiaries, identifying potential risk factors for NMS and shedding light on the incidence of NMS in children and adolescents. The study provides valuable insights into the public health significance of NMS in young people and sets a template for future research in this area. [Extracted from the article]

The article discusses a case of α‐Methylacyl‐CoA racemase (AMACR) deficiency in a 56-year-old female with unique neurological features, including ataxia, spasticity, and segmental dystonia. AMACR deficiency is a rare disorder characterized by elevated levels of certain acids and can manifest in adulthood or the neonatal period. The patient's diagnosis was confirmed through genetic testing and laboratory findings, highlighting the importance of considering AMACR deficiency in patients with undiagnosed cerebellar ataxia and seizure. The article emphasizes the need for timely diagnosis and appropriate management in such cases. [Extracted from the article]

Parkinson's disease (PD) is a neurodegenerative disorder characterized by both motor and non-motor symptoms (NMS). NMS including sleep disturbances, depression, anxiety, and constipation are diverse, can precede motor symptoms, and significantly impact patients' quality of life. The severity and type of NMS vary based on age, disease severity, and motor symptoms, and while some respond to dopaminergic treatments, others may be induced or exacerbated by such treatments. NMS also play a role in differentiating PD from drug-induced parkinsonism and are related to gait dysfunction in both early and advanced stages. Genetic factors play a significant role in the development of NMS in PD, with mutations in genes such as SNCA, LRRK2, PRKN, and GBA being associated with severe and early NMS. Familial studies and identification of susceptibility factors have provided insights into the genetic underpinnings of NMS in PD. Neurobehavioral changes, including cognitive decline, are common NMS in PD, and their genetic basis involves a spectrum of mutations shared with other neurodegenerative disorders. Further research is needed to elucidate the functional implications of these genetic factors and their contributions to the pathogenesis of NMS in PD. [ABSTRACT FROM AUTHOR]

Objective: The objective was to determine the prevalence and clinical correlates of nonmotor symptoms in Parkinson's disease patients in movement disorders outpatient clinics. Methods: We enrolled all consecutive PD patients who visited our movement disorders outpatient clinics between January and December 2023; and agreed to participate in the study. In addition to the evaluation of demographic and clinical features, clinical scales, including the MDS-UPDRS, NMSS, and FOOGQ, were performed. Results: Overall, we enrolled 163 PD subjects with a mean age of 63.9 ± 10.4 (F/M = 27/136). The disease duration was 3.5 (20) y [median (range)]. The median score of the NMSS was 41 points. The NMSs burden levels were severe in 25.2%, and very severe in 25.2% of the subjects. The subitems with the highest scores were sleep/fatigue, mood/cognition, urinary, and miscellaneous. The analyses within the patient group with newly diagnosed PD also revealed high NMSS scores. Comparisons of the NMSS between distinct PD stages revealed greater NMSS scores in the severe stage than in the mild stage (p = 0.001). Correlation analyses between the clinical scores and the NMSS scores revealed positive correlations between the NMSS scores and the scores on all the clinical scales including the MDS-UPDRS 1–4, and FOGQ. Conclusion: We reported the first data regarding the NMS burden in PD patients from Turkey. We found a high prevalence and severity of various domains of NMSs, most of which were sleep/fatigue, mood/cognition, urinary, and miscellaneous. More than half of the patients had severe to very severe NMS burden. Although NMSs were more common severe-stage disease, they were also prevalent in the subgroup with newly diagnosed patients. [ABSTRACT FROM AUTHOR]

Abstract Background Neuroleptic malignant syndrome (NMS) is a rare and potentially life‐threatening condition that may arise at any point during treatment and is often associated with adverse reactions to dopamine‐blocking agents. This syndrome is normally characterized by features such as muscle rigidity, alteration in consciousness, autonomic instability, and leukocytosis. Aim The aim of this study is to investigate a borderline intellectual functioning (BIF) case in which NMS with insidious disease progression and long prodromal symptoms was developed. Case Presentation The investigated patient was a 38‐year‐old female diagnosed with bipolar disorder and a variety of corresponding disorders. The patient exhibited gastrointestinal symptoms and restlessness in the weeks leading up to the study, subsequent to the administration of elevated doses of haloperidol, risperidone, and lithium. In addition, she was hospitalized for restlessness and aggressiveness in the summer of 2023. Furthermore, due to her chief complaint, she received parenteral haloperidol twice in the emergency room, subsequently experiencing fever, altered consciousness, generalized rigidity, and dysphagia. Moreover, the patient's initial creatine phosphokinase (CPK) level was 2550 IU/L, and she was hospitalized in an intensive care unit with the diagnosis of NMS for 8 days. Conclusions This case study highlights the necessity of being attentive about prodromal symptoms of NMS and emergent interventions.

Neuroleptic Malignant Syndrome (NMS) is a rare and potentially fatal complication that can occur after exposure to dopamine-blocking drugs, especially antipsychotic medications. Symptoms of NMS include fever, severe muscle rigidity, and dysautonomia. The exact cause of NMS is not known, but it is believed to be related to the blockade of dopamine receptors in the central nervous system. NMS can be difficult to diagnose, as it can mimic other disorders such as serotonin syndrome, malignant hyperthermia, and anti-NMDA receptor encephalitis. Treatment for NMS is empirical and typically involves muscle relaxants and close monitoring in an intensive care unit. While the risk of recurrence is low, some risk remains. [Extracted from the article]

Background: Sensorial non-motor symptoms (NMSs) in Parkinson's disease (PD) still lack appropriate investigation in clinical practice. This study aimed to assess if and to what extent auditory dysfunction is associated with other NMSs in PD and its impact on patient's quality of life (QoL). Methods: We selected patients with idiopathic PD, without other concomitant neurological diseases, dementia, or diagnosis of any audiological/vestibular disease. Demographic and clinical data were collected. Patients underwent otoscopic examination, audiological testing with pure tone audiometry (PTA) and distortion product otoacoustic emissions (DPOAEs) and completed Non-Motor Symptoms Scale (NMSS) and Parkinson's Disease Questionnaires-39 (PDQ-39). ANCOVA and partial correlation analysis have been used for statistical analysis. Results: 60 patients were enrolled and completed PTA and DPOAEs. 32 patients with hearing impairment (HI), assessed by PTA, (hearing threshold ≥ 25 dB) showed similar disease duration, motor impairment, and staging, compared to patients without HI, but higher scores both in NMSS and in PDQ-39, except for cardiovascular (CV), gastrointestinal (GI), urogenital (U) and sexual function (SF) of NMSS. In addition, DPOAEs showed a significant correlation with higher scores both in NMSS and PDQ-39, except for CV, SF, GI, U and perceptual problem subdomains of NMSS. Conclusion: This study demonstrated that PD patients with HI have a greater burden of NMS and lower related QoL and functioning. Our results highlight the importance to reconsider HI as a NMS, in parallel with the others. HI evaluation, even in asymptomatic patients, may reveal a wider pathology with a worse QoL. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) is a progressive neurodegenerative disorder, involving motor and non-motor symptoms (NMS). Sleep disturbances (SD) are the second most common NMS in PD and include rapid eye movement (REM) sleep behavior disorder (RBD), excessive daytime sleepiness and insomnia. Freezing of gait (FOG) is a gait impairment frequently reported in people with PD greatly hampering functional independence and quality of life. Presence of FOG has been associated with increased frequency and severity of NMS, including SD. Thus, the aim of this study was to systematically review the literature comparing the number of people with FOG in PD with (PD + SD) and without SD (PD-SD). By systematically searching PubMed and Web of Science databases to identify original peer-reviewed articles, 8 studies including 5251 people with PD (2025 PD + SD and 3226 PD-SD) met eligibility criteria and were included in the review. In 6 studies (4 studies investigating RBD, 2 studies investigating overall sleep quality), the group of PD + SD had higher prevalence of FOG compared with PD-SD. Although a limited number of studies, our findings suggest that PD + SD present more frequently FOG than PD-SD. More studies are required to investigate the possible mechanism underlying this association between FOG and sleep. • Sleep disturbances in PD and include rapid eye movement , sleep behavior disorder, daytime sleepiness, and insomnia. • FOG in PD has been linked to increased frequency and severity of non-motor symptoms, including sleep disturbances. • A systematic review was conducted, involving 8 studies with a total of 5251 people with PD (2025 PD + SD and 3226 PD-SD). • Individuals with PD and sleep disturbances (PD + SD) are more likely to experience FOG than (PD-SD). • The exact mechanism underlying the association between FOG and sleep disturbances requires further investigation. [ABSTRACT FROM AUTHOR]

Introduction and purpose: The number of invented and produced medications has increased over recent years. Besides their positive impact on health, they invariably provide various kinds of side effects. This review is focused on malignant neuroleptic syndrome, a rare condition with no fully confirmed pathogenesis, which at least partially can be explained as an adverse effect of blocking dopamine receptors. Even though it usually affects psychiatric or neurological patients, doctors of all medical specializations should stay alert, as the condition can often lead to premature death. Brief description of knowledge: The main symptoms associated with NMS are hypertonia, hyperpyrexia, autonomic instability and altered consciousness. They can appear in any configuration, sometimes followed by less characteristic manifestations. It should be primarily differentiated from serotonin syndrome, malignant hyperpyrexia and catatonia, mostly through the interview of those who have taken medications and undergone surgeries, as there are not any specific lab tests available. Fundamental treatment methods consist of neuroleptic withdrawal, intensive supportive care, drug administration and eventually ECT. Summary: NMS is an uncommon, severe disease that should be carefully considered in patients treated with neuroleptics. Due to its rarity and sudden onset, it appears to be problematic to conduct widespread research and studies, so there are still no concrete, consistent and unquestioned guidelines on recognizing and treating the condition. [ABSTRACT FROM AUTHOR]

Background: Neuroleptic malignant syndrome (NMS) is a rare and potentially life‐threatening condition that may arise at any point during treatment and is often associated with adverse reactions to dopamine‐blocking agents. This syndrome is normally characterized by features such as muscle rigidity, alteration in consciousness, autonomic instability, and leukocytosis. Aim: The aim of this study is to investigate a borderline intellectual functioning (BIF) case in which NMS with insidious disease progression and long prodromal symptoms was developed. Case Presentation: The investigated patient was a 38‐year‐old female diagnosed with bipolar disorder and a variety of corresponding disorders. The patient exhibited gastrointestinal symptoms and restlessness in the weeks leading up to the study, subsequent to the administration of elevated doses of haloperidol, risperidone, and lithium. In addition, she was hospitalized for restlessness and aggressiveness in the summer of 2023. Furthermore, due to her chief complaint, she received parenteral haloperidol twice in the emergency room, subsequently experiencing fever, altered consciousness, generalized rigidity, and dysphagia. Moreover, the patient's initial creatine phosphokinase (CPK) level was 2550 IU/L, and she was hospitalized in an intensive care unit with the diagnosis of NMS for 8 days. Conclusions: This case study highlights the necessity of being attentive about prodromal symptoms of NMS and emergent interventions. [ABSTRACT FROM AUTHOR]

Objective: Bradykinesia and rigidity are considered closely related motor signs in Parkinson disease (PD), but recent neurophysiological findings suggest distinct pathophysiological mechanisms. This study aims to examine and compare longitudinal changes in bradykinesia and rigidity in PD patients treated with bilateral subthalamic nucleus deep brain stimulation (STN‐DBS). Methods: In this retrospective cohort study, the clinical progression of appendicular and axial bradykinesia and rigidity was assessed up to 15 years after STN‐DBS in the best treatment conditions (ON medication and ON stimulation). The severity of bradykinesia and rigidity was examined using ad hoc composite scores from specific subitems of the Unified Parkinson's Disease Rating Scale motor part (UPDRS‐III). Short‐ and long‐term predictors of bradykinesia and rigidity were analyzed through linear regression analysis, considering various preoperative demographic and clinical data, including disease duration and severity, phenotype, motor and cognitive scores (eg, frontal score), and medication. Results: A total of 301 patients were examined before and 1 year after surgery. Among them, 101 and 56 individuals were also evaluated at 10‐year and 15‐year follow‐ups, respectively. Bradykinesia significantly worsened after surgery, especially in appendicular segments (p < 0.001). Conversely, rigidity showed sustained benefit, with unchanged clinical scores compared to preoperative assessment (p > 0.05). Preoperative motor disability (eg, composite scores from the UPDRS‐III) predicted short‐ and long‐term outcomes for both bradykinesia and rigidity (p < 0.01). Executive dysfunction was specifically linked to bradykinesia but not to rigidity (p < 0.05). Interpretation: Bradykinesia and rigidity show long‐term divergent progression in PD following STN‐DBS and are associated with independent clinical factors, supporting the hypothesis of partially distinct pathophysiology. ANN NEUROL 2024;96:234–246 [ABSTRACT FROM AUTHOR]

BackgroundNeuroleptic malignant syndrome (NMS) is a rare but potentially life-threatening adverse drug reaction. This study aims to identify the most prevalent drugs associated with the risk of NMS according to the United States Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database.MethodsAnalyses were performed using data from the FAERS database from January 2004 to June 2024. Single-drug signals were evaluated using the reporting odds ratio (ROR), proportional reporting ratio (PRR), information component (IC), and empirical Bayes geometric mean (EBGM). Meanwhile, comparisons were performed with drug labels. Additionally, subgroup analysis was conducted, focusing on adverse drug reaction signals among populations of different genders and age groups.ResultsA total of 10,433 adverse event reports related to NMS were identified, with the top 50 drugs ranked by ROR mainly involving antipsychotics (18, 36%), antiparkinson drugs (10, 20%), antidepressants (7, 14%), antiepileptics (3, 6%), anxiolytics (3, 6%), as well as hypnotics and sedatives (3, 6%). NMS is more prevalent in males (5,713, 54.76%). Among the top 20 drugs with the strongest signal strength, the pediatric group showed an additional presence of benzodiazepines and antiepileptic drugs compared to the adult group.ConclusionThe current comprehensive pharmacovigilance study identified more drugs associated with NMS and provides references to clinicians for clinical practice. Also, further research is needed to investigate the causal relationship between these drugs and NMS.

Euglycemic ketoacidosis (EKA) has been reported as a rare but life‐threatening complication of continuous renal replacement therapy (CRRT). EKA should be suspected in the setting of persistent high anion gap metabolic acidosis despite renal replacement therapy. Critically ill patients, especially those with diabetes mellitus, are at risk of EKA due to deficient caloric intake, the presence of excess counterregulatory stress hormones, and nutritional losses from CRRT. Even with the use of glucose‐containing dialysates, EKA can be observed. Prompt treatment with insulin and glucose‐containing infusions leads to rapid resolution of the condition. Early optimization of nutritional intake can prevent or mitigate EKA. This case report describes a patient who developed EKA while on CRRT for severe acute kidney injury from neuroleptic malignant syndrome. [ABSTRACT FROM AUTHOR]

Niemann-Pick Type-C (NPC) disease, an autosomal recessive lysosomal storage disorder, is associated with a spectrum of neuropsychiatric manifestations, including catatonia, which may not respond to conventional treatment. Here we report the case of a patient with adult-type NPC disease who developed catatonia and experienced recurrent catatonic episodes after the administration of antipsychotics required to treat active psychotic symptoms. Despite unsuccessful attempts with lorazepam, clozapine, and memantine to treat the catatonic symptoms, the patient showed improvement with electroconvulsive therapy (ECT). Catatonia recurred shortly after ECT discontinuation and improved with resuming ECT and adding lorazepam. However, catatonia recurred when the ECT frequency was reduced. We were able to resolve the catatonia with a combination of ECT and lorazepam. However, when we reduced the frequency of ECT sessions, the catatonia recurred despite continued lorazepam treatment. Remarkably, the addition of lamotrigine to the patient's treatment resulted in complete remission with no further recurrence of catatonia for 8 months. Our case highlights lamotrigine's mood-stabilizing effect and possible anti-NMDA effect in treating and preventing recurrent catatonia. [ABSTRACT FROM AUTHOR]

The article discusses the importance of therapeutic drug monitoring (TDM) in optimizing treatment with antipsychotic medications. It emphasizes the need for personalized treatment regimens and effective communication between healthcare providers and patients. The article also provides a detailed overview of typical and atypical antipsychotic medications, their dosages, indications, and monitoring levels. Additionally, it highlights the challenges and benefits of TDM in psychiatric practice, including the impact of factors like age, sex, genetics, and drug interactions on treatment outcomes. The study underscores the potential of TDM in improving treatment efficacy, reducing adverse effects, and enhancing patient safety, while acknowledging the need for further research to establish clear concentration-effect relationships for newer antipsychotics. [Extracted from the article]

Abstract Objective This study aimed to analyze and map scientific literature on Neuroleptic Malignant Syndrome (NMS) and Serotonin Syndrome (SS) from prestigious, internationally indexed journals. The objective was to identify key topics, impactful articles, prominent journals, research output, growth patterns, hotspots, and leading countries in the field, providing valuable insights for scholars, medical students, and international funding agencies. Methods A systematic search strategy was implemented in the PubMed MeSH database using specific keywords for NMS and SS. The search was conducted in the Scopus database, renowned for its extensive coverage of scholarly publications. Inclusion criteria comprised articles published from 1950 to December 31st, 2022, restricted to journal research and review articles written in English. Data were analyzed using Microsoft Excel for descriptive analysis, and VOSviewer was employed for bibliometric mapping. Results The search yielded 1150 articles on NMS and 587 on SS, with the majority being case reports. Growth patterns revealed a surge in NMS research between 1981 and 1991, while SS research increased notably between 1993 and 1997. Active countries and journals differed between NMS and SS, with psychiatry journals predominating for NMS and pharmacology/toxicology journals for SS. Authorship analysis indicated higher multi-authored articles for NMS. Top impactful articles focused on review articles and pathogenic mechanisms. Research hotspots included antipsychotics and catatonia for NMS, while SS highlighted drug interactions and specific medications like linezolid and tramadol. Conclusions NMS and SS represent rare but life-threatening conditions, requiring detailed clinical and scientific understanding. Differential diagnosis and management necessitate caution in prescribing medications affecting central serotonin or dopamine systems, with awareness of potential drug interactions. International diagnostic tools and genetic screening tests may aid in safe diagnosis and prevention. Reporting rare cases and utilizing bibliometric analysis enhance knowledge dissemination and research exploration in the field of rare drug-induced medical conditions.

Abstract Neuroleptic malignant syndrome is a rare, life-threatening neurologic emergency characterized by fever, rigidity, autonomic instability, mental status changes, and an elevated creatine kinase level. It often occurs shortly after the initiation of neuroleptic treatment, or after a dose increase. The management of patients with NMS is based upon clinical severity and includes supportive care and withdrawal of antipsychotic agents and agents like bromocriptine and dantrolene. Complications include acute renal failure associated with rhabdomyolysis, respiratory failure, electrolyte imbalance, hepatic failure, seizures from hyperthermia, metabolic derangements, etc.

Introduction: The Neuroleptic Malignant Syndrome (NMS), alternatively referred to as the Antipsychotic Malignant Syndrome, is a potentially fatal condition that is infrequently observed and is linked to the administration of antipsychotic medications. This syndrome is characterized by a disturbance in consciousness, autonomic instability manifesting as hyperthermia, and muscular rigidity. The onset of this syndrome is typically within the initial month of treatment or following an escalation in the dosage of an antipsychotic medication. This case report delineates a case where NMS was precipitated by an excessive intake of haloperidol, a typical antipsychotic drug. Case description: In the Emergency Department (ED), a 23-year-old male was admitted following an overdose of haloperidol, a typical antipsychotic drug. The patient exhibited symptoms of tachypnea and tachycardia, and initially presented with hypotension. His level of consciousness was variable, but maximal upon stimulation. Notably, there was a significant increase in muscle tension, characterized by cogwheel rigidity. His body temperature rose to 38.6 degrees Celsius. Laboratory findings revealed a substantial high anion gap metabolic acidosis, with a lactate level of 21.2 mmol/L. Additionally, his creatine kinase level was elevated, measuring 1347 U/L. The therapeutic approach encompassed the intravenous administration of midazolam (2.5 mg), lorazepam (2.5 mg), and biperiden (5 mg), in conjunction with resuscitation involving 2 liters of 0.9% NaCl. The patient demonstrated a positive response to this regimen, leading to his admission to the ward. Following a full recovery, he was discharged from the hospital the subsequent day. Discussion: The patient in our case fulfilled all the diagnostic criteria for NMS as stipulated in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). NMS is not contingent on the dosage, although an increased dosage does elevate the risk. A thorough review of existing literature did not yield any cases mirroring ours. Conclusion: In conclusion, we present a case where NMS developed after an overdose of haloperidol.

This article explores the important role of Parkinson's Nurse Specialists (PNS) in the management of Parkinson's disease (PD). PD is a degenerative brain disease that affects both motor and non-motor symptoms, impacting a person's quality of life and increasing care requirements. The PNS role has evolved in the UK, providing clinical, educational, research, and consultation support to patients. While there is limited evidence on the efficacy of the PNS role, studies have shown positive outcomes in terms of patient well-being and quality of life. However, there is a global shortage of PNS, particularly in low and middle-income countries, due to factors such as nurse shortages and inadequate funding. The article emphasizes the need for increased recognition and support for the PNS role to improve the management of PD worldwide. [Extracted from the article]

This article discusses two cases brought before the European Court of Human Rights involving individuals who were placed in psychiatric hospitals against their will and subjected to psychiatric treatment. In the first case, a Moldovan national alleged abandonment and forced medication, resulting in a life-threatening condition. The court initially sentenced the mayor responsible for finding a solution for the individual, but the Supreme Court of Justice later acquitted the mayor. The second case involved a 15-year-old child with an intellectual disability who experienced delays in discharge, was transferred to the adults' section, and received psychiatric treatment. The court found violations of the European Convention on Human Rights, including the prohibition of ill-treatment, discrimination, and the right to an effective remedy. The Moldovan state was required to address the systemic issues identified in the cases. [Extracted from the article]

The article presents questions and answers related to adjunctive agents for suboptimal response to clozapine, combination of clozapine and a first-generation antipsychotic for treatment of neuroleptic malignant syndrome, management of the adverse effects of clozapine, and changes in the frequency of complete blood count monitoring and absolute neutrophil count.

Neuroleptic malignant syndrome is a rare, life-threatening neurologic emergency characterized by fever, rigidity, autonomic instability, mental status changes, and an elevated creatine kinase level. It often occurs shortly after the initiation of neuroleptic treatment, or after a dose increase. The management of patients with NMS is based upon clinical severity and includes supportive care and withdrawal of antipsychotic agents and agents like bromocriptine and dantrolene. Complications include acute renal failure associated with rhabdomyolysis, respiratory failure, electrolyte imbalance, hepatic failure, seizures from hyperthermia, metabolic derangements, etc. [ABSTRACT FROM AUTHOR]

The prevalence of autism has been increasing at an alarming rate. Even accounting for the expansion of autism spectrum disorder diagnostic (ASD) criteria throughout the 1990's, there has been an over 300% increase in ASD prevalence since the year 2000. The often debilitating personal, familial, and societal sequelae of autism are generally believed to be lifelong. However, there have been several encouraging case reports demonstrating the reversal of autism diagnoses, with a therapeutic focus on addressing the environmental and modifiable lifestyle factors believed to be largely underlying the condition. This case report describes the reversal of autism symptoms among dizygotic, female twin toddlers and provides a review of related literature describing associations between modifiable lifestyle factors, environmental exposures, and various clinical approaches to treating autism. The twins were diagnosed with Level 3 severity ASD "requiring very substantial support" at approximately 20 months of age following concerns of limited verbal and non-verbal communication, repetitive behaviors, rigidity around transitions, and extensive gastrointestinal symptoms, among other common symptoms. A parent-driven, multidisciplinary, therapeutic intervention involving a variety of licensed clinicians focusing primarily on addressing environmental and modifiable lifestyle factors was personalized to each of the twin's symptoms, labs, and other outcome measures. Dramatic improvements were noted within several months in most domains of the twins' symptoms, which manifested in reductions of Autism Treatment Evaluation Checklist (ATEC) scores from 76 to 32 in one of the twins and from 43 to 4 in the other twin. The improvement in symptoms and ATEC scores has remained relatively stable for six months at last assessment. While prospective studies are required, this case offers further encouraging evidence of ASD reversal through a personalized, multidisciplinary approach focusing predominantly on addressing modifiable environmental and lifestyle risk factors. [ABSTRACT FROM AUTHOR]

Background: Acute febrile encephalopathy (AFE) in spite of being a common clinical condition is less known to the general population thereby resulting in delay in seeking medical attention with detrimental consequences. The causes can range from infectious central nervous system (CNS) and systemic diseases to non-infectious conditions such as neuroleptic malignant syndrome, poisoning, and drug overdose. Early diagnosis and prompt medical management can result in good clinical outcome in terms of morbidity and mortality. Aims and Objectives: The aims and objectives are to study the clinical profile, etiology, seasonal variation, and outcome in patients admitted as case of AFE in a tertiary care hospital. Materials and Methods: All patients of AFE fulfilling the inclusion and exclusion criteria admitted in the departments of neurology and general medicine in Batra Hospital and Medical Research Centre (BHMRC) New Delhi, a tertiary care hospital were subjected to study analysis. The patients underwent detailed history, examination, baseline, and special investigations such as cerebrospinal fluid and magnetic resonance imaging brain whenever needed. Patients of AFE were studied according to the prevalence, etiological diagnosis, and seasonal variations. The final outcome at discharge was based on modified Rankin scale (mRs). Results: About 122 serially admitted patients diagnosed with AFE were found eligible and included in the study. About 47 (45%) patients had acute pyogenic CNS infection while as 36 (35%) had non-pyogenic CNS infection followed by malarial, tubercular, and cryptococcal CNS infection. We found maximum number of cases (n=61, 50%) of AFE during monsoon followed by 36 patients (30%) in post-monsoon, 15 patients (12%) were in summer, and only 10 cases (8%) during winter. We found higher and statistically significant disability in CNS infection group, patients with delayed hospitalization (P=0.001), and lower Glasgow coma scale (0.00001). Conclusion: AFE being a condition with serious consequences, we conclude that clinical suspicion, sensitization, and swift response from the treating physicians are required to avoid worse outcomes associated with the delayed diagnosis and late hospitalization of these patients. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to analyze and map scientific literature on Neuroleptic Malignant Syndrome (NMS) and Serotonin Syndrome (SS) from prestigious, internationally indexed journals. The objective was to identify key topics, impactful articles, prominent journals, research output, growth patterns, hotspots, and leading countries in the field, providing valuable insights for scholars, medical students, and international funding agencies. Methods: A systematic search strategy was implemented in the PubMed MeSH database using specific keywords for NMS and SS. The search was conducted in the Scopus database, renowned for its extensive coverage of scholarly publications. Inclusion criteria comprised articles published from 1950 to December 31st, 2022, restricted to journal research and review articles written in English. Data were analyzed using Microsoft Excel for descriptive analysis, and VOSviewer was employed for bibliometric mapping. Results: The search yielded 1150 articles on NMS and 587 on SS, with the majority being case reports. Growth patterns revealed a surge in NMS research between 1981 and 1991, while SS research increased notably between 1993 and 1997. Active countries and journals differed between NMS and SS, with psychiatry journals predominating for NMS and pharmacology/toxicology journals for SS. Authorship analysis indicated higher multi-authored articles for NMS. Top impactful articles focused on review articles and pathogenic mechanisms. Research hotspots included antipsychotics and catatonia for NMS, while SS highlighted drug interactions and specific medications like linezolid and tramadol. Conclusions: NMS and SS represent rare but life-threatening conditions, requiring detailed clinical and scientific understanding. Differential diagnosis and management necessitate caution in prescribing medications affecting central serotonin or dopamine systems, with awareness of potential drug interactions. International diagnostic tools and genetic screening tests may aid in safe diagnosis and prevention. Reporting rare cases and utilizing bibliometric analysis enhance knowledge dissemination and research exploration in the field of rare drug-induced medical conditions. [ABSTRACT FROM AUTHOR]

Neuroleptic malignant syndrome (NMS) is a serious side effect of antipsychotic drugs. Alcohol withdrawal delirium and NMS can present with similar symptoms and hence can create confusion. We present a case of a young male who had no underlying medical illness except alcohol use disorder but developed NMS with a single dose of haloperidol (5 mg) in withdrawal delirium state. Alcohol has been reported to cause polymorphism in the D2 dopamine receptors, which is also the site of action for antipsychotic medicines. Apart from this, dehydration, physical exhaustion, and restraint use may have increased the risk of NMS in our patient. We managed both the conditions, alcohol withdrawal delirium and NMS, simultaneously with lorazepam and bromocriptine.

Abstract Background Significant elevation of creatine kinase levels (above three digits) and leucocytosis in the absence of muscle rigidity, tremors, or autonomic dysfunction can pose a real challenge in the context of antipsychotic treatment as an early herald of neuroleptic malignant syndrome. Case presentation We present here two cases of adult male patients of Black British heritage, ages 51 years and 28 years, respectively. Both received a diagnosis of schizoaffective disorder and presented with massive increase of creatine kinase blood level after aripiprazole depot administration, one with pernicious increase associated with silent neuroleptic malignant syndrome, and the second with asymptomatic benign enzyme elevation. Conclusion Though aripiprazole use is less likely to cause neuroleptic malignant syndrome, on rare occasions it can produce massive symptomatic or asymptomatic increase in serum creatine kinase enzyme levels, raising the need for close monitoring, especially at the initial doses of the drug.

Introduction Serotonin syndrome and neuroleptic malignant syndrome are caused by 2 distinct pathologies; however, the clinical presentation associated with both syndromes share many features. Methods We describe a 56-year-old male patient who presented to our facility with seizures, leukocytosis, fevers, extremity hyperreflexia, and signs of autonomic dysfunction as evidenced by cardiovascular instability. The patient was noted to be taking vortioxetine, trazodone, lamotrigine, lurasidone, and carbidopa-levodopa as outpatient medications for his depression, an unspecified mood disorder, and Parkinson disease. Following a robust workup and failure of other therapies, all serotonergic and dopaminergic medications were held, and the patient was tried on cyproheptadine for serotonin syndrome, which led to the cessation of fevers. Bromocriptine was added to the regimen, which led to the resolution of the remainder of the patient’s symptoms. Results The overlapping symptomatology of several key diagnostic criteria for both serotonin syndrome and neuroleptic malignant syndrome as well as their nature as diagnoses of exclusion require an evaluation of the patient’s aggregate improvement following targeted pharmacologic strategies for both syndromes. The efficacy of both cyproheptadine and bromocriptine when administered concomitantly support the concurrent pathologies. Discussion Clinicians at the bedside must be cognizant of the potential for clinically relevant drug-drug interactions that may present with overlapping pathologies.

Optical Coherence Tomography (OCT) is a high-resolution imaging technique that can be used to identify various eye conditions and retinal signatures of systemic diseases. It has shown promise in detecting neurodegenerative diseases such as Alzheimer's Disease, Parkinson's Disease, and Motor Neurone Disease. Two studies using large datasets have found that OCT can identify retinal markers associated with Parkinson's Disease and differentiate atypical Parkinsonism cases. Another study has explored the potential of combining OCT measurements with polygenic risk scores to predict cognitive decline. These findings suggest that OCT may have clinical potential in detecting and managing neurodegenerative diseases at an earlier stage. However, further research is needed to improve phenotyping and understand the pathological mechanisms in the retina. [Extracted from the article]

Background: Significant elevation of creatine kinase levels (above three digits) and leucocytosis in the absence of muscle rigidity, tremors, or autonomic dysfunction can pose a real challenge in the context of antipsychotic treatment as an early herald of neuroleptic malignant syndrome. Case presentation: We present here two cases of adult male patients of Black British heritage, ages 51 years and 28 years, respectively. Both received a diagnosis of schizoaffective disorder and presented with massive increase of creatine kinase blood level after aripiprazole depot administration, one with pernicious increase associated with silent neuroleptic malignant syndrome, and the second with asymptomatic benign enzyme elevation. Conclusion: Though aripiprazole use is less likely to cause neuroleptic malignant syndrome, on rare occasions it can produce massive symptomatic or asymptomatic increase in serum creatine kinase enzyme levels, raising the need for close monitoring, especially at the initial doses of the drug. [ABSTRACT FROM AUTHOR]

Introduction: Mood stabilisers and other psychotropic drugs can lead to serious adverse drug events (ADEs). However, the incidence remains unknown.We aimed to (a) determine the incidence of serious ADEs in patients with bipolar or schizoaffective disorders, (b) explore the role of lithium exposure, and (c) describe the aetiology. Methods: This study is part of the LiSIE (Lithium--Study into Effects and Side Effects) retrospective cohort study. Between 2001 and 2017, patients in the Swedish region of Norrbotten, with a diagnosis of bipolar or schizoaffective disorder, were screened for serious ADEs to psychotropic drugs, having resulted in critical, post-anaesthesia, or intensive care. We determined the incidence rate of serious ADEs/1,000 person-years (PY). Results: In 1,521 patients, we identified 41 serious ADEs, yielding an incidence rate of 1.9 events per 1,000 PY. The incidence rate ratio (IRR) between ADEs with lithium present and causally implicated and ADEs without lithium exposure was significant at 2.59 (95% CI 1.20--5.51; p = 0.0094). The IRR of ADEs in patients <65 and ≥65 years was significant at 3.36 (95% CI 1.63--6.63; p = 0.0007). The most common ADEs were chronic lithium intoxication, oversedation, and cardiac/blood pressure-related events. Discussion: Serious ADEs related to treatment of bipolar (BD) or schizoaffective disorder (SZD) were uncommon but not rare. Older individuals were particularly at risk. The risk was higher in individuals exposed to lithium. Serum lithium concentration should always be checked when patients present with new or unclear somatic symptoms. However, severe ADEs also occurred with other mood stabilisers and other psychotropic drugs. [ABSTRACT FROM AUTHOR]