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Geriatric Psychopharmacology: A Complex Case of Psychosis Complicated by Neuroleptic Malignant Syndrome (NMS) and Metabolic Syndrome (MetS)

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Abstract

Treating psychosis in the elderly can be a significant challenge. The potential for clinical difficulty due to the complex interactions between enzymes, multiple receptor subtypes, and individual variations is highlighted. Here, we present a complex case of psychosis complicated by neuroleptic malignant syndrome and metabolic syndrome. We have outlined the relevant pharmacokinetics, pharmacodynamics, risk factors, and management strategies which can be applied when confronted with multiform cases such as the one presented here.

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Abbreviations

ALT:

Alanine transaminase

AMPK:

Adenosine monophosphate-activated protein kinase

AST:

Aspartate transaminase

BUN:

Blood urea nitrogen

CPK:

Creatine phosphokinase

CVD:

Cardiovascular disease

CYP:

Cytochrome P 450

GABA:

Gamma-amniobutyric acid

HDL:

High-density lipoprotein

LDL:

Low-density lipoprotein

LFT:

Liver function test

MetS:

Metabolic syndrome

NMS:

Neuroleptic malignant syndrome

PPAR α:

Peroxisome proliferator-activated receptor alpha

SSRI:

Selective serotonin reuptake inhibitors

START:

Screening Tool to Alert doctors to Right Treatment

STOPP:

Screening Tool of Older Person’s Prescriptions

TNFα:

Tumor necrosis factor alpha

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Author information

Authors and Affiliations

  1. Northern Ontario School of Medicine, Laurentian and Lakehead University, Sudbury, ON, Canada

    Raj Velamoor MB, FRCPsych (UK), FRCP (C)

  2. Schulich School of Medicine, Western University, London, ON, Canada

    Raj Velamoor MB, FRCPsych (UK), FRCP (C)

  3. Medical University of the Americas, St. Kitts and Nevis University of Toronto at Mississauga, Mississauga, ON, Canada

    Gautham Pulagam MD, BSc

Authors
  1. Raj Velamoor MB, FRCPsych (UK), FRCP (C)
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  2. Gautham Pulagam MD, BSc
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Editors and Affiliations

  1. Department of Psychiatry, Northern Ontario School of Medicine Psychiatry Department, Sudbury, Ontario, Canada

    Kuppuswami Shivakumar

  2. Woodstock General Hospital, Woodstock Ontario, University of Western Ontario, London, Ontario, Canada

    Shabbir Amanullah

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Velamoor, R., Pulagam, G. (2018). Geriatric Psychopharmacology: A Complex Case of Psychosis Complicated by Neuroleptic Malignant Syndrome (NMS) and Metabolic Syndrome (MetS). In: Shivakumar, K., Amanullah, S. (eds) Complex Clinical Conundrums in Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-319-70311-4_3

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  • DOI: https://doi.org/10.1007/978-3-319-70311-4_3

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