Momma yɛnhu Neuroleptic Malignant Syndrome, tebea a asiane wom a nnuru a ɛma ntini mu yare de ba no!

Ebia wo anaa obi a wunim no renom aduru bi a wɔfrɛ no neuroleptic, a wɔde sa adwenemyare ahorow bi. Bere a nnuru yi betumi aboa nnipa pii kɛse no, nsɛm bi wɔ hɔ a ɛntaa nsi koraa a nnuru yi betumi de tebea bi a ɛyɛ hu, na ɛde nkwa mpo ato asiane mu aba. Ɛno ne nea yɛfrɛ no Neuroleptic Malignant Syndrome (NMS). Ɛyɛ din a ɛyɛ den, nanso ɛho hia sɛ wuhu ho asɛm.

Dɛn ne Ntini mu Ntini a Ɛyɛ Fɛ (NMS)? Momma yɛnte ase kɛkɛ!

Sɛ yɛbɛka no tiawa a, neuroleptic malignant syndrome (NMS) yɛ adeyɛ a ɛntaa nsi koraa na ebetumi de obi nkwa to asiane mu wɔ nnuru kuw bi a wɔfrɛ no neuroleptics (a wɔsan frɛ no nnuru a ekum adwene mu yare) ho. Wɔde nnuru yi di dwuma de di adwenemyare pii ho sɛnkyerɛnne ahorow ho dwuma na wɔsa .

Wobetumi ahu sɛnkyerɛnne atitiriw pii wɔ saa `NMS` tebea yi mu:

• Atiridiinini a emu yɛ den (hyperthermia) a obi wɔ .
• Ntini a ɛwɔ nipadua no mu no mu yɛ den na ɛyɛ yaw (sɛ eyi kɔ so a, ntini no betumi apaapae mpo).
• Nsakrae a ɛba adwene mu tebea mu (te sɛ adwene mu naayɛ, nkae a wɔhwere).
• Autonomic nervous system a ɛnyɛ adwuma yiye anaasɛ dysautonomia.

Yɛn autonomic nervous system no te sɛ automatic system a ɛwɔ yɛn nipadua mu no. Ɛhwɛ nneɛma te sɛ mogya mmoroso ne ahome a wɔhome so. Sɛ ɛnyɛ adwuma yiye a, mogya mmoroso betumi akɔ soro na akɔ fam mpofirim, ama fifiri ayɛ no dodo (secondary hyperhidrosis), na ama nnompe atu dodo.

NMS yɛ aduruyɛ mu tebea a egye ntɛmpɛ a ɛde nnipa nkwa to asiane mu, na ehia sɛ wɔde wɔn kɔ ayaresabea ntɛm ara. Enti, sɛ wuhu saa sɛnkyerɛnne ahorow yi a, ade a eye sen biara a ɛsɛ sɛ woyɛ ne sɛ wobɛkɔ ayaresabea ntɛm ara.

Dɛn ne nnuru a ɛma ntini mu yare yi?

Wobetumi akyekyɛ nnuru a ɛma ntini mu yare, anaa nnuru a ekum adwene mu yare no mu akuw atitiriw abien.

1. Awo ntoatoaso a edi kan anaasɛ "typical" antipsychotics.

2. Awo ntoatoaso a ɛto so abien anaa "atypical" antipsychotics.

Nnuruyɛfo kyerɛw nnuru a ekum adwene mu yare awo ntoatoaso a edi kan ne nea ɛto so abien yi ma adwene ne ntini mu yare ahorow. Nhwɛso kakraa bi ni:

• Suban mu haw ahorow a ɛba wɔ adwenemhaw mu.
• Adwene a ɛma obi yɛ ade tra so.
• Hahaahayɔ.
• Adidi mu haw ahorow.
• Dadwen a ɛkɔ so wɔ ɔkwan a ɛkɔ akyiri so.
• Nkwakoraa ne mmerewa ho basabasayɛ.
• Asoroben.
• Ɔhaw a ɛma obi yɛ ade tra so (OCD).
• Nipasu mu ɔhaw ahorow.
• Adwennwen a ɛba wɔ ahodwiriw akyi (PTSD).
Schizoaffective yare a ɛma obi yɛ ade tra so. Schizophrenia ne nyarewa a ɛbata ho.

Nnuru bɛn na ebetumi ama obi anya neuroleptic malignant syndrome (NMS)?

Nnuru ahorow pii wɔ hɔ a ebetumi de `NMS` aba. Momma yɛnhwɛ nea wɔyɛ.

Nnuru a wɔtaa de sa ntini mu yare (a ɛko tia adwenemhaw):

• Bromperidol a wɔfrɛ no Bromperidol
• Chlorpromazine `(Klorpromazine)`
• Clopenthixol a wɔde yɛ nnuru
• Fluphenazine `(Fluphenazine)`
• Haloperidol `(Haloperidol)`
• Loxapine a wɔde ma
• Promazine a wɔde yɛ nnuru
• Thioridazine `(Tioridazine)`
• Thiothixene a wɔde yɛ nnuru
• Trifluoperazine `(Trifluoperazine)`

Nnuru a ɛmma ntini mu yare (a ɛko tia adwene mu yare) a ɛnyɛ nea wɔtaa de di dwuma:

• Amisulpride a wɔde yɛ aduru
• Aripiprazole a wɔde ma
• Clozapine a wɔde di dwuma
• Olanzapine a wɔde ma
• Quetiapine a wɔde ma
• Risperidone a wɔde ma
• Ziprasidone a wɔde ma
• Zotepine a wɔde di dwuma

Nnuru bi a wɔde kum akisikuru:

• Domperidone a wɔde ma
• Droperidol `(Droperidol)`
• Metoclopramide a wɔde di dwuma
• Prochlorperazine `(Prochlorperazine)` a wɔde di dwuma
• Promethazine a wɔde ma

Dopaminergic (Parkinson) nnuru (denam eyinom a wobegyae mpofirim so):

• Amantadine a wɔde di dwuma
• Nnuru a ɛma dopamine yɛ adwuma
• Levodopa a wɔfrɛ no Levodopa
• Tolcapone a wɔde di dwuma

Mma saa nsɛm a wɔahyehyɛ yi nnyɛ wo hu. Ɛnyɛ obiara a ɔnom nnuru yi na obenya NMS. Eyi yɛ tebea a ɛntaa nsi koraa . Nanso sɛ worenom nnuru yi a, ɛho hia sɛ wuhu eyi.

Nsonsonoe bɛn na ɛda NMS ne ɔhyew a ɛboro so a ɛyɛ hu ntam?

Ebia woate tebea bi a wɔfrɛ no malignant hyperthermia nso ho asɛm. Ɛyɛ adeyɛ a ɛntaa nsi, a emu yɛ den nso. Nanso nnuru a wɔde kum nipadua no yare ne nnuru a ɛma ntini mu dwo na ɛde ba .

Ebetumi nso ama ntini ahorow ayɛ den, ntini a ɛma nipadua no yɛ adwuma no so atew (hyporeflexia), na honam ani nsakrae (blue, redness). Saa sɛnkyerɛnne ahorow yi betumi ayɛ te sɛ NMS de no. Nanso, nnuruyɛfo betumi ahu nsonsonoe a ɛda abien no ntam denam ɔyarefo no aduruyɛ ho abakɔsɛm a wɔbɛhwɛ so. Ɛne sɛ, sɛ́ ebia wɔayɛ wɔn aduru a wɔde kum nipadua no nnansa yi anaasɛ wɔanom aduru bi a ɛma ntini mu yare no.

Nsonsonoe bɛn na ɛda NMS ne Serotonin Syndrome ntam?

Serotonin syndrome yɛ tebea foforo a ɛma adwene tu fra. Nnuru a ɛka serotonergic kuw no ho, te sɛ nnuru bi a ekum adwenemhaw, amphetamines, nnuru a ekum histamine, ne nnuru a ɛma obi adwene tu fra na ɛde ba. Sɛ yɛbɛka no tiawa a, ɛba bere a nnuru bi a wɔfrɛ no serotonin wɔ nipadua no mu dodo no.

Serotonin yare no ho sɛnkyerɛnne bi ne ntini a ɛyɛ den, hyperreflexia, atiridiinini, fifiri, ntini a ɛtwetwe (myoclonus), ne adwene mu tebea a ɛsakra. Nanso , mpɛn pii no atiridii ne ntini a ɛyɛ den no ntaa mma wɔ serotonin yare no mu sen NMS mu.

Wo duruyɛfo no behu nsonsonoe a ɛda tebea abien yi ntam denam wo yare no ho sɛnkyerɛnne ne nnuru a worenom a obetie no so.

Henanom na wonya neuroleptic malignant syndrome (NMS)?

NMS betumi aba obiara a ɔnom nnuru a ɛma ntini mu yare (a ɛko tia adwenemhaw) so.

Ɛwom sɛ wosusuw sɛ NMS nsɛm no mu bɛyɛ nkyem abiɛsa mu abien ba wɔ dapɛn a edi kan a wofi ase de nnuru a ɛma ntini mu yare di dwuma no mu de, nanso ɛho hia sɛ wɔkae sɛ saa tebea yi betumi aba bere biara bere a wɔreyɛ ayaresa no.

Saa `NMS` tebea yi abu so dɛn?

Nokwarem no, neuroleptic malignant syndrome (NMS) yɛ tebea a ɛntaa nsi koraa. Ɛba wɔ nnipa a wɔnom nnuru a ɛma ntini mu yare no mu 0.01% kosi 3.2% mu .

Nanso, asɛmpa no ne sɛ amanneɛbɔ dodow a ɛfa NMS ho no so retew esiane nnuru foforo a wɔde aba a asiane a ɛwɔ hɔ sɛ ɛde NMS bɛba no sua, ne nnuruyɛfo ne ayarefo nimdeɛ a wɔwɔ wɔ tebea yi ho nti.

Dɛn ne neuroleptic malignant syndrome (NMS) ho sɛnkyerɛnne?

`NMS` ho sɛnkyerɛnne taa fi ase da adi wɔ da biako kosi abiɛsa ntam . Nsɛnkyerɛnne titiriw a ɛkyerɛ ne sɛ:

• Atiridiinini a ano yɛ den yiye (digrii Fahrenheit 102 kosi 104 - digrii Celsius 38.9 kosi 40).
• Koma mu nnyigyei a ɛnkɔ so pɛpɛɛpɛ (arrhythmia).
• Koma a ɛbɔ kɛse (tachycardia).
• Ɔhome a ɛkɔ soro (tachypnea).
• Ntini a ɛyɛ den/a ɛyɛ den `(ntini a ɛyɛ den)`.
• Nsakrae a ɛba adwene mu tebea mu (te sɛ adwene mu naayɛ, basabasayɛ, adwene a ɛyera).
• Mogya mmoroso anaa mogya mmoroso a ɛba fam.
• Fifiri a ɛboro so.

Sɛ wowɔ saa sɛnkyerɛnne yi mu biako anaa nea ɛboro saa, titiriw sɛ worenom aduru a ɛma ntini mu yare a, yɛsrɛ wo frɛ 911 anaa kɔ ayaresabea a ɛbɛn wo ntɛm ara. Eyi yɛ aduruyɛ mu asɛm a egye ntɛmpɛ.

Ɔkwan bɛn so na neuroleptic nnuru de `NMS` ba?

`NMS` tebea no fi aduru bi a ɛma ntini mu yare (antipsychotic) mu.Ebetumi aba bere a wɔde dodow biako pɛ di dwuma, sɛ wɔma dodow no kɔ soro, anaasɛ wɔkɔ so de dodow koro no ara di dwuma. Ɛwom sɛ NMS ne awo ntoatoaso a edi kan nnuru a ekum adwene mu yare wɔ abusuabɔ titiriw de, nanso ebetumi aba nso, wɔ ɔkwan ketewaa bi so, bere a wɔtwe awo ntoatoaso a ɛto so abien nnuru a ekum adwenemhaw, nnuru bi a ekum akisikuru, ne nnuru a ɛma dopaminergic a wɔde di dwuma ma Parkinson yare no fi hɔ mpofirim no.

Nyansahufo da so ara rebɔ mmɔden sɛ wobehu nea ɛde NMS ba ankasa. Mprempren nsusuwii ne sɛ ɛnam dopamine D2 receptor antagonism so na ɛba . Dopamine yɛ neurotransmitter a ɛwɔ yɛn amemene mu. Ɛyɛ nnuru a ɛde nkrasɛm kɔ nkwammoaa ntam. Nnuru a ɛma ntini mu yare yɛ adwuma denam dopamine ɔbɔfo yi a esiw kwan sɛ ɛnfa ntini pɔtee bi so nkɔ nkwammoaa mu no so.

Sɛ dopamine a ɛwɔ wo hypothalamus ne/anaasɛ w’akyi berɛmo mu no siw a, ntini mu nhyɛso kɔ soro. Afei nso, dopamine agyefo a ɛwɔ hypothalamus no mu a wɔsɛe no ne nea ɛde atiridiinini kɛse ne nsakrae kɛse a ɛba mogya mmoroso mu a wohu wɔ NMS mu no ba.

Ɔkwan bɛn so na wohu sɛ obi anya neuroleptic malignant syndrome (NMS)?

Sɛ nnuruyɛfo betumi ahu NMS a, ɛsɛ sɛ wunya sɛnkyerɛnne anaa tebea horow a edidi so yi nyinaa :

• Worenom aduru bi a ɛma ntini mu yare anaasɛ woagyae aduru a ɛma ntini mu yare nom mpofirim.
• Wowɔ ntini a ɛyɛ den/ɛyɛ den (eyi betumi mpo ama ntini no mu apaapae).
• Wowɔ atiridiinini kɛse.
• Nsakrae bi ba w’adwene mu.

Bio nso, anyɛ yiye koraa no, ɛsɛ sɛ su horow a edidi so yi mu abien wɔ hɔ:

• Fifiri a ɛboro so anaasɛ ɛyɛ soronko.
• Ɛyɛ den sɛ wobɛmene.
• Nsu anaa nsu a wontumi nni so (incontinence).
• Koma a ɛbɔ kɛse (tachycardia).
• Mpofirim ara a ontumi nkasa.
• Mogya mmoroso a ɛkɔ soro anaasɛ ɛtaa ba.
• Mogya mu nkwammoaa fitaa dodow a ɛkɔ soro (Leukocytosis).
• Creatine phosphokinase (CPK) dodow a ɛkɔ soro esiane ntini a ɛpaapae nti.
• Nneɛma a ɛma obi tumi yɛ ade brɛoo anaasɛ ɛyɛ kakraa bi (hyporeflexia).

Sɔhwɛ bɛn na wɔyɛ de hu `NMS`?

Sɛ wo duruyɛfo susuw sɛ wowɔ NMS a, wobetumi ahyɛ sɛ wɔnyɛ nhwehwɛmu te sɛ:

• Metabolic panel a ɛyɛ pɛpɛɛpɛ.
• Nsu mu nhwehwɛmu.
• Mogya mu mframa a ɛwɔ ntini mu anaa ntini mu nhwehwɛmu.
• Creatine phosphokinase (CPK) mogya mu nhwehwɛmu.

Ɔkwan bɛn so na wɔsa neuroleptic malignant syndrome (NMS) no?

NMS yɛ aduruyɛ mu asɛm a egye ntɛmpɛ. Enti ɛho hia sɛ wohu tebea no na wofi ase sa yare ntɛm. Sɛ wowɔ NMS a, ɛda adi sɛ ɛho behia sɛ wɔde wo kɔ ayaresabea.Ɛho behia sɛ wonya ayaresa wɔ baabi a wɔhwɛ wɔn a wɔyare denneennen (ICU).

Wɔ `NMS` nsɛm nyinaa mu no, nnuruyɛfo begyae neuroleptic (antipsychotic) aduru a ɛde `NMS` bae no ntɛm ara. Bio nso, wɔbɛsa `NMS` ho sɛnkyerɛnne na wɔayɛ anammɔn bi de asiw nsɛnnennen a ebetumi aba ano. Ebia ayaresa ahorow yi bi ne:

• Koma ne ɔhome a ɛbɛkɔ so agyina pintinn denam mfiri a wɔde ma mframa, nnuru a ɛko tia apɔw-mu-teɛteɛ, ne/anaasɛ mfiri a ɛma koma no yɛ den a wɔde bedi dwuma so.
• Electrolyte a wɔbɛma ayɛ pɛ wɔ nipadua no mu denam nsu a wɔde fa ntini mu (IV nsu) a wɔde bɛma so.
• Nipadua mu hyew a wɔbɛtew so denam ntama a ɛma onwini, nsukyenee nsu, ne/anaasɛ nsukyenee a wɔde ahyɛ mu so.
• Sɛ mogya mmoroso yɛ kɛse a, fa nnuru di so.
• Nnuru te sɛ heparin a wɔde bɛma na amma mogya antɔ.
• Nnuru a ebetumi ama nipadua no mu dopamine dodow a ɛba fam no asan de ama.
• Ntini anaa nnompe a ɛma obi dwo a wɔde ma.

Dɛn ne asiane ahorow a ɛwɔ hɔ ma `NMS` a wobenya?

Nneɛma pii wɔ hɔ a ɛma asiane a ɛwɔ hɔ sɛ obi benya neuroleptic malignant syndrome (NMS) no yɛ kɛse:

• Aduru foforo a ɛma ntini mu yare (a ɛko tia adwenemhaw) a wobefi ase anaasɛ dodow a wɔbɛma akɔ soro.
• Nnuru a ɛboro biako a wɔde ma ntini mu yare a wɔde bedi dwuma anaasɛ aduru a wɔfrɛ no lithium a wɔde bedi dwuma.
• Dopaminergic aduru bi a wɔde sa Parkinson yare a wogyae mpofirim.

Bere tenten ahe na ebegye na woanya ahoɔden afi `NMS` mu? (Nkɔmhyɛ) .

Sɛ wohu NMS ntɛm na wɔsa no ntɛm na ɛfata a, nnipa dodow no ara ho tɔ wɔn wɔ adapɛn abien kosi nnafua 14 ntam.

Nanso, sɛ wɔkyɛ ayaresa no a, nsɛnnennen a emu yɛ den betumi aba a ɛka ntini, asaabo, koma, ne/anaasɛ ahurututu.

Sɛ wɔansa NMS yare ntɛm a, ebetumi akum obi. Nnipa dodow a wowuwu wɔ NMS ho no fi 5% kosi 20%. Nanso, NMS ho nimdeɛ a ɛkɔ soro ne nnuru foforo a wɔde kum adwenemhaw a wɔde di dwuma no ama nnipa dodow a wowuwu yi so atew wɔ mfe du du kakraa a atwam no mu.

Nnipa pii, wɔ oduruyɛfo akwankyerɛ ase, tumi san fi nnuru a wɔde sa ntini mu yare (a ɛko tia adwenemhaw) ase yiye.

Dɛn ne nsɛnnennen a ɛwɔ neuroleptic malignant syndrome (NMS) mu?

Nea ɛyɛ awerɛhow no, NMS ho nsɛnnennen abu so na emu yɛ den. Nsɛnnennen bi fi NMS ne autonomic nervous system dysfunction ho sɛnkyerɛnne ahorow a ɛda nsow, bere a afoforo, titiriw nyarewa, betumi afi baabi a wɔhwɛ wɔn a wɔyare denneennen (ICU) a wɔtra hɔ kyɛ no mu aba.

NMS ho nsɛnnennen bi ne:

• Rhabdomyolysis (ntini mu nkwammoaa a ɛpaapae - eyi ne ɔhaw a ɛtaa ba).
• Nsu a ɛho ntew.
• Asaabo a entumi nyɛ adwuma yiye.
• Ɔhome a entumi nyɛ adwuma yiye.
• Akisikuru tebea horow/ akisikuru .
• Koma mu ntini a ɛyɛ mmerɛw.
• Mogya a ɛtwetwe nipadua no nyinaa (Disseminated intravascular coagulation).
• mmerɛbo a entumi nyɛ adwuma yiye.
• Ahurututu mu yare.
• Sepsis (mmoawa a ɛhyɛn mogya mu).
• Nsuo mu yareɛ (UTI).
• Ahurututu mu ntini a ɛma mogya tu.

Esiane sɛ saa nsɛnnennen yi mu yɛ den na ɛde nkwa to asiane mu nti, ɛho hia yiye sɛ wobɛfrɛ 911 ntɛm ara na sɛ wowɔ NMS ho sɛnkyerɛnne bi a, wokɔ ayaresabea a ɛbɛn wo no kɔhwɛ ayaresa. Bio nso, NMS yɛ ntɛmpɛ a ɛde nkwa to asiane mu na ebia ebehia ayaresa wɔ Intensive Care Unit (ICU).

Bere bɛn na ɛsɛ sɛ mekɔ me duruyɛfo nkyɛn?

Sɛ worenom nnuru a ɛma ntini mu yare (antipsychotics), nnuru a ekum akisikuru, ne/anaasɛ dopaminergic (Parkinson) nnuru biako anaa nea ɛboro saa a, ɛho hia sɛ wokɔ wo duruyɛfo nkyɛn daa na woahwɛ ahu sɛ ɛreyɛ adwuma yiye ama wo. Afei nso, bisa wo duruyɛfo no nsunsuanso bɔne a ɛwɔ nnuru a wonom no mu ne sɛnkyerɛnne ahorow a ɛsɛ sɛ wohwɛ so yiye.

So ɛsɛ sɛ mekɔ Emergency Department (ETU) sɛ mewɔ `NMS` ho sɛnkyerɛnne a?

Sɛ wowɔ neuroleptic malignant syndrome (NMS) ho sɛnkyerɛnne te sɛ atiridiinini a ano yɛ den yiye ne ntini a ɛyɛ den a, ɛho hia sɛ wofrɛ 911 anaa wokɔ ayaresabea a ɛbɛn wo ntɛm ara. NMS hwehwɛ sɛ wɔde ayaresa kɔ ayaresabea ntɛm ara. Sɛ wɔansa no ntɛm na wɔansa no yiye a, ebetumi ama obi awu mpo.

Neuroleptic malignant syndrome (NMS) yɛ tebea a emu yɛ den a ɛde nkwa to asiane mu. Enti sɛ wowɔ sɛnkyerɛnne ahorow a, ɛho hia sɛ wokɔ ayaresabea ntɛm ara sɛnea wubetumi. NMS yɛ mmerɛw kɛse sɛ wɔbɛsa sɛ wɔkyere no ntɛm a. Ɛwom sɛ NMS ntaa mma de, nanso sɛ worenom nnuru a ɛma ntini mu yare (a ɛko tia adwenemhaw) a, wo ne wo duruyɛfo anaa nnuruyɛfo nkasa mfa nsunsuanso bɔne ne sɛnkyerɛnne ahorow a ɛsɛ sɛ wohwɛ yiye wɔ ho. Wɔwɔ hɔ sɛ wɔbɛboa wo.

Nneɛma a ɛho hia sen biara a yesua fii asɛm yi mu (Take-Home Message) .

Okay, enti momma yɛnkae wo nneɛma a ɛho hia paa a ɛsɛ sɛ wode sie w'adwene mu firi deɛ yɛaka ho asɛm wɔ saa `NMS` yi mu:

• NMS yɛ tebea a ɛntaa nsi, nanso ebetumi de nkwa ato asiane mu a nnuru a ɛma ntini mu yare na ɛde ba.
• Atiridiinini a ano yɛ den, ntini mu yaw, ne adwene mu basaayɛ ne sɛnkyerɛnne atitiriw.
• Sɛ wuhu saa sɛnkyerɛnne ahorow yi bi a, hwehwɛ aduruyɛfo afotu ntɛm ara. Ntwentwɛn wo nan ase.
• Sɛ worenom nnuru a ɛma ntini mu yare a, wo ne wo duruyɛfo nka aduru no ne nea efi mu ba ho asɛm. Nsuro sɛ wubebisa nsɛm.
• Sɛ wohu na wɔsa ntɛm a, wobetumi asa NMS koraa.

Yɛwɔ anidaso sɛ wɔde saa nsɛm yi abɔ wo amanneɛ. Kɔ so nya apɔwmuden!

` Neuroleptic Malignant Syndrome, NMS, nnuru a wɔde sa adwenemyare, nea efi mu ba, atiridiinini a emu yɛ den, ntini a ɛyɛ den