Neuroleptic syndrome in patients with alcoholism: types, symptoms and signs, treatment and diagnosis

As a result of taking antipsychotics, as well as dopaminuperating drugs, a variety of adverse reactions may develop, one of which is neuroleptic syndrome.

Neuroleptic syndrome in patients with alcoholism

This condition refers to dangerous side reactions that may occur in the patient during the course of therapy or after its termination, when the appropriate drugs are canceled.
Antipsychotic therapy is actively used in relation to alcohol dependence, but in strictly limited drug dosages. Although some patients have enough of this dose, so that the body responds to the treatment of neuroleptic syndrome.

This complication significantly worsens the patient's existence, leading to disability and negative socialization.

Reasons for

There is no clear list of factors contributing to the development of neuroleptic syndrome. Most experts are inclined to believe that disorders of a neurological origin arise from the blocking of dopamine receptors and subsequent compensatory reactions, which causes the imbalance of substances involved in the neuroimpulse transfer process and the breakdown of the connections between the subcortical substance and the thalamus.

Although the occurrence of neuroleptic syndrome can trigger the use of any antipsychotic drug, most often such a reaction is observed in typical means. In patients with alcoholism, such a reaction is detected much more often, and in the form of a malignant neuroleptic syndrome.

Scheme of action of neuroleptics

Clinical forms of

Neuroleptic syndrome can develop in a variety of clinical manifestations characterized by symptomatic manifestations, therefore they should be considered individually:

  • Acute dystonia;
  • Malignant neuroleptic syndrome;
  • Akathisia;
  • Neuroleptic Parkinsonism;
  • Late dyskinesia.

Neuroleptic Parkinsonism

A similar form of the syndrome is considered the most common and is found in half of the patients undergoing neuroleptic treatment. This clinical form develops mainly in elderly women already at the initial stage of treatment.

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The characteristic symptom of this form of neurolepsy are:

  • Stiffness of muscle tissue;
  • Delayed motor activity;
  • Movement is intermittent;
  • Facial expression becomes meager;
  • Limbs tremble;
  • Active salivation is present;
  • There are social, cognitive and emotional disorders such as a lack of ability to get pleasure, indifference to the environment, the gradual disappearance of social relationships, etc.

A characteristic difference of this form from parkinsonism is the absence of progression of manifestations, the symmetry of neurological disorders is traced. To get rid of the syndrome, the withdrawal of the medication and the replacement with another medication are indicated. Soon after taking the necessary measures, the symptoms of neuroleptic syndrome recede.

If Parkinsonism is stable, then detoxification of extracorporeal therapy like plasmapheresis or hemosorption is indicated.

Acute dystonia

For a similar shape, involuntary slow or cyclically repeated rapid movements leading to flexion-extension of limbs or the body are characteristic. An acute dystonic form is found in about 4% of patients, with a similar form to the particularly early complications of neuroleptic therapy.

Statistics show that such a complication is usually formed in the first 5 days after the start of therapy with psychotic drugs or increase their dosage. A similar condition can develop even after switching from one method of reception to another, for example, when the intake of tablets is replaced by injections.

Acute dystonia is more common in young male patients who have not reached the age of 30 and who have alcohol dependence.

For acute dystonia are typical:

  • Dystonic spasms of cervical and head muscle tissues;
  • Involuntary opening of mouth or loss of tongue;
  • Krivosheya, tipping the head back or turning it;
  • Invisible grimaces;
  • Eyeglassed eyes, etc.

To eliminate the syndrome, it is necessary to cancel or significantly reduce the dosage of the antipsychotic.

Akathisia

This condition is defined as a craving for constant movement in order to reduce emotional and psychological discomfort and internal anxiety. A similar condition occurs in about 20% of patients undergoing antipsychotic therapy, mainly in the first week or after the course.

The akathisia is characterized by manifestations:

  • Internal depressing discomfort, causing the patient to involuntarily move;
  • Stereotyped motor activity like frequent changes in posture, fidgeting, tapping with fingers or feet, scratching of the ear, head, face, etc.

Late dyskinesia

This form is distinguished by a late onset. It is often called extrapyramidal syndrome. Especially often, pathology is found in elderly women with alcoholism. The syndrome begins with involuntary muscle twitches on the face in the form of smacking, tongue-showing, chewing-sucking facial expressions, etc. Severe degrees of tardive dyskinesia are accompanied by pharyngo- and laryngospasm, respiratory disorders, after which spasms affect the muscles of the limbs and the body, causing the patient to unconsciously move the brushes orfingers, while the process of walking becomes distorted.

Visible manifestations of tardive dyskinesia

Deficient

The deficit form is called the iatrogenic defect. The clinical picture of a similar form of neurolepsy is similar to schizophrenia and manifests itself:

  • Lethargy;
  • The inhibition of psychophysical functions;
  • Apathetic condition;
  • Speech retardation;
  • Weakness;
  • Disturbed concentration of attention;
  • Stupidity;
  • Indifference;
  • Emotional meagerness, etc.

When the dose is lowered or the medication is withdrawn, the symptomatology of the syndrome is reduced or completely disappears.

Malignant neuroleptic syndrome

A similar form of the syndrome is relatively rare, but is considered the most dangerous for a person. Most often it develops in people who have alcohol dependence, smokers, with nervous system pathologies, brain injuries, etc.

For the malignant form of neuroleptic syndrome is characteristic:

  • The presence of vegetative disorders like incontinence, pressure spikes, rapid breathing or ripple, etc.;
  • Increase in body temperature;
  • Excessive muscle tone;
  • Disturbances of consciousness;
  • Mental manifestations such as stupor, anxiety, delirium, hallucinations and other psychopathic disorders.

Patients with a similar form of neuroleptic syndrome require intensive care, because there is a high probability of death( 10-12% of cases).

Symptoms and signs

There are several degrees of development of the syndrome of neurolepsy:

  • Early;
  • Tightening;
  • Chronic.

The protracted form of the syndrome develops against a background of prolonged neuroleptic treatment or after drug withdrawal, and the violations caused by such therapy are eliminated for many months.

Chronic neuroleptic syndrome is preceded by long-term neuroleptic therapy, and the symptoms typical for the syndrome can persist for the rest of their life.

Diagnostics of

Diagnosis of such syndromes is complicated by the similarity with many independent pathological conditions and involves the use of a variety of hardware, laboratory techniques, as well as psychiatric counseling.

Treatment of

Is the disease on its own?- no. Treatment of neuroleptic syndrome depends on its form. Often to stop the disease, it is sufficient to cancel or reduce the dosage of drugs. The usual neuroleptic is replaced by an atypical form, diazepam. Assign funds holinolitiki like Trihexifendil or Biperidena, vitamin B₆.Sometimes additional appointment of β-blockers like Anaprilin or Propranolol is indicated.

In case of late neuroleptic dystonia, administration of botulinum toxin and administration of anticonvulsant clonazepam and others are indicated. Late dyskinesia requires the administration of tocopherol and central sympatholytic agents such as Reserpine. With malignant neuroleptic syndrome, qualified emergency care is needed, as treatment in an intensive care unit with antipyretics, amantadines, diazepam, heparin, electroconvulsive therapy is indicated.

Forecasts

Early diagnosis of neuroleptic syndrome and timely withdrawal of antipsychotic medication provide a favorable outcome of the disease. But, unfortunately, there is always a risk of relapse of this condition. In addition, brain structures that do not damage the patient's life can not be completely lost, provoking the development of various neurological disorders. And with malignant neuroleptic syndrome there is a real risk of death.

Video lecture on neuroleptic syndrome:

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