Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

They can occur in a number of conditions, such as bipolar disorder [62], major depressive disorder [28], borderline state [63], schizoaffective disorder, overdose of psychoactive substances induced by drug use short psychosis (for example, stimulant psychosis, whose symptoms are similar to schizophrenia), schizophrenic disorder.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Currently, there is no laboratory test for diagnosing schizophrenia [48].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Sometimes, during diagnosis, general medical or neurological examinations are carried out to exclude somatic diseases that occasionally lead to psychotic schizophrenic-like conditions [48]: disorders metabolism, systemic infections, syphilis, HIV, epilepsy and brain damage.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

It may be necessary to exclude delirium, which is distinguished by the presence of visual hallucinations, acute onset, fluctuations in the level of consciousness, and indicates a latent somatic disease.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

For differential diagnosis, it is desirable to conduct a full medical examination, including a physical examination, a clinical blood test, a biochemical blood test (including a study liver, kidney and thyroid function), urinalysis, ECG, pregnancy test, drug screening [28].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Two systems are used to classify forms of schizophrenia: the Diagnostic and Statistical Manual of Mental Disorders (now DSM-5) published by the American Psychiatric Association, and the International Classification of Diseases by the World Health Organization (currently ICD-10).


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The ICD is used in European countries, Russia, Ukraine, and the DSM is used in the United States and some English-speaking countries of the world.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The ICD criteria give more weight to Schneiderian symptoms of the first rank, but in practice both systems are very similar [64].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

WHO has developed the SCAN (English: Schedules for Clinical Assessment in Neuropsychiatry) toolkit that can be used in the diagnosis of a number of psychiatric conditions, including schizophrenia.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

ICD-10 criteria


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The following are the official general criteria for paranoid, hebephrenic, catatonic, and undifferentiated schizophrenia (F20.0—F20.3) [65].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

According to ICD-10, at least one of the following symptoms must be observed for diagnosis:


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

(a) The “echo” of thoughts (the sound of one's own thoughts), the insertion or withdrawal of thoughts, the openness of thoughts to others.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

(b) Delusions of mastery, influence, or passivity that are clearly related to the body or limbs, thoughts, actions or sensations; delusional perception.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

(c) Hallucinatory “voices” commenting on or discussing the patient's behavior; other types of “voices” coming from different parts of the body.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

(d) Persistent delusions that are culturally inadequate, ridiculous, impossible, and/or grandiose in content.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Alternatively, at least two of the following “smaller” symptoms should be present:


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

(e) Persistent hallucinations of any kind if they occur daily for at least one month and are accompanied by delusions (which can be unstable and semi-formed) without a distinct affective content.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

(f) Neologisms, sperrungs (interruptions in thinking), leading to rupture or inconsistency in speech.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

(g) Catatonic behaviors, such as agitation, stiffening, or waxy flexibility, negativism, mutism, and stupor.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

(h) “Negative symptoms” (but not due to depression or pharmacotherapy), usually leading to social exclusion and lower social indicators; symptoms that may be expressed by:


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

apathy


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

speech impoverishment or smoothness


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

inadequacy of emotional reactions


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

(i) Reliable and consistent changes in the overall quality of behavior, manifested by loss of interests, aimlessness, absorption in one's own experiences, social alienation.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Diagnostic instructions


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

At the same time, these symptoms should be noted for at least a month.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Conditions that meet these criteria, but last less than a month, are classified as acute schizophrenic-like psychotic disorder (with an additional fourth sign indicating character disorders), and if they subsequently last more than a month, the diagnosis is changed (recoded) to the appropriate form of schizophrenia [65].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

With the development of symptoms of schizophrenia along with severe symptoms of other disorders (affective: manic or depressive episodes, epileptic, other brain diseases, alcohol or drug intoxication or withdrawal syndrome), the diagnosis of schizophrenia is not made, and appropriate diagnostic categories and codes are applied.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

A diagnosis of schizophrenia is made if the case meets the criteria for a manic episode - or depressive episode (-), but the above general criteria are identified before the development of a mood disorder [65].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

symptom


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

(i) in the above list refers only to the diagnosis of “simple schizophrenia” (), and requires a psychiatrist to monitor symptoms for at least one year [65].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

DSM Criteria


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

According to DSM IV-TR and DSM-5, schizophrenia is diagnosed when the following diagnostic criteria are met [48] [66]:


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

(A) Characteristic symptoms (Two or more of the following, each present for most of the month, or less if treatment has interrupted symptoms):


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

delusional ideas;


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

hallucinations;


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

disorganized speech (e.g. frequent slippage or inconsistency; abstract speech content).


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

See thinking disorders;


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

severely disorganized (e.g. inappropriate clothing choices, frequent crying) or catatonic behavior


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

negative symptoms, including the plane of affect (absence or decrease in the brightness of emotional reactions), alogy (silence or impoverishment of speech), or abulia (reduced or absent motivation).


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Note: If delusions are considered fantastic, or hallucinations are one voice commenting on the patient's current actions or two or more voices talking to each other, it is enough to have only one symptom of all of the above.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The criterion for disorganization of speech is sufficient only when it radically disrupts communication with the patient.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

(B) Social/Occupational Dysfunction: For a significant part of the time since the onset of the disorder, the level of achievement in work, relationships or personal care is much lower than before illness, and if the disease began in childhood, the inability to reach the expected level in human relationships, work, or study.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

(C) Duration: Symptoms last at least half a year.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Of this, six months for at least one month, the symptoms meet criterion (A) (active phase), and the rest of the time (residual and prodromal phase), there are negative symptoms or At least two of the criteria (A) symptoms persist in an erased, weakened form (for example, strange beliefs or unusual sensory experiences).


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

(D) Schizoaffective disorder and depressive or bipolar disorder with psychotic signs are excluded.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Either there are no depressive, manic, or mixed episodes during the active phase, or their duration is short compared to the total duration of the active and residual phases.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

(E) The reason is not taking drugs or drugs or some kind of physical illness.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

(F) If the patient has autism or other developmental disabilities, the diagnosis of schizophrenia requires that severe delusions or hallucinations last at least a month (or less in the case of successful treatment).


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Subtypes


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Historically, in Western countries, schizophrenia has been divided into simple, catatonic, gebephrenic (then disorganized), and paranoid.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

DSM


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Previously, the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV and DSM-IV-TR) contained five subtypes of schizophrenia:


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Paranoid type: delusions and hallucinations are present, but there are no thinking disorders, behavioral disorganization, and affective flattening (ICD-9-code 295.3, ICD-10-code F20.0).


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Disorganized type: in the ICD it is called “gebephrenic schizophrenia”.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

A combination of thinking disorders and flattening of affect is characteristic (ICD-9 295.1, ICD-10 F20.1).


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Catatonic type: conspicuous psychomotor disorders.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Symptoms may include catatonic stupor and waxy flexibility (ICD-9 295.2, ICD-10 F20.2).


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Undifferentiated type: psychotic symptoms are present, but criteria for paranoid, disorganized or catatonic type are not met (ICD-9 295.9, ICD-10 F20.3).


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Residual type: there are positive symptoms, but they are mild (ICD-9 295.6, ICD-10 F20.5).


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

In the fifth edition (DSM-5), the American Psychiatric Association removed all subtypes of schizophrenia due to their “limited diagnostic stability, low reliability, and poor validity” [67] [68].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

In DSM-IV, schizophrenia subtypes existed “due to strong clinical traditions” [69] [70].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

According to the authors of the DSM, studies conducted since then have not been able to confirm the “usefulness” of isolating forms of schizophrenia.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

A review of 24 studies with 38 “tests” performed on the basis of a study of 28 cohorts of patients did not allow us to confirm the concept of the presence of classical forms of schizophrenia [69] [71].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The researchers also found no differences in response to therapy and differences in the features of the course when comparing subtypes of schizophrenia [69].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Instead of dividing into forms, DSM-5 introduces “psychopathological dimensions” (English: psychological dimensions), which, according to the authors, should better describe the heterogeneity of schizophrenia and are more clinically beneficial [69].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

MKB


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

In the ICD, in addition to paranoid, hebephrenic, catatonic, undifferentiated, residual (residual), more subtypes are identified:


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Post-schizophrenic depression: a depressive episode that occurs after the reduction of schizophrenic symptoms, with the possible presence of some weakened symptoms of schizophrenia (ICD-10 F20.4).


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Simple schizophrenia: gradually developing negative symptoms that gradually take on a severe form, in the absence of a history of psychotic episodes (ICD-9 295.0, ICD-10 F20.6).


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Another type of schizophrenia: senestopathic schizophrenia and schizophrenic disorder/psychosis of BDU (ICD-10 F20.8) are included [72].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

However, there is no description of senestopathic schizophrenia in the ICD-10.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

In the version of ICD-10 adapted for use in the Russian Federation, another type of schizophrenia (F20.8) includes hypochondriac schizophrenia (ICD-10 F20.8xx1), senestopathic schizophrenia (ICD-10 F20.8xx2), pediatric schizophrenia (ICD-9 299.91, ICD-10 F20.8xx3), atypical forms of schizophrenia (ICD-9 295.81, ICD-10 F20.8xx4), schizophrenia of other established types (ICD-9 295.8, ICD-10 F20.8xx8).


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

But all these diagnostic units, except for senestopathic schizophrenia, are absent in the version of ICD-10 presented by the World Health Organization in 2016 [72] and are present only in version of ICD-10 modified for use in the Russian Federation.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

In ICD-10, they are considered subtypes of schizotypic disorder (subsection codes are present only in the version adapted for the Russian Federation):


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Latent schizophrenia (ICD-10 F21.1).


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Prepsychotic schizophrenia and prodromal schizophrenia are included.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Schizophrenic reaction (ICD-10 F21.2).


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Pseudoneurotic schizophrenia (ICD-10 F21.3).


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Pseudopathic schizophrenia (ICD-10 F21.4).


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Borderline schizophrenia is included.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Symptomatic poor schizophrenia (ICD-10 F21.5).


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

It is manifested mainly by negative symptoms.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Also, in the version of ICD-10 adapted for use in the Russian Federation, there is paranoia schizophrenia (F22.82), in which predominantly querulant (vexatious), erotic nonsense, nonsense are distinguished invention or reform, as well as a delusional form of dysmorphophobia.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Paranoia schizophrenia with sensitive relationship delusions has the code F22.03.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

They are categorized as delusional disorders (F22).


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

However, the original version of ICD-10 presented to WHO in 2016 does not contain these concepts [72].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

In ICD-11, starting with the beta version, following the American Psychiatric Association and DSM-5, all subtypes of schizophrenia have been removed [73].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

ICD-11 highlights:


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Schizophrenia, episode one


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Schizophrenia, a few episodes


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Schizophrenia, continuous


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

6A20.Y Other specified schizophrenia


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

6A20.Z Unspecified schizophrenia


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

As well as additional codes to indicate the prevailing symptoms (): positive, negative, depressive, manic, psychomotor, cognitive.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Disease prevalence


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Schizophrenia is equally common in both sexes, but in men it usually begins earlier, with a peak incidence of 20—28 years compared to 26—32 years in women [74].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Schizophrenia is much less common in early childhood [75],


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

cases of late (onset in middle age) and very late (in old age) schizophrenia are also rare [76].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Lifetime prevalence is usually reported at 1%, but a systematic review of studies conducted in 2002 yielded a result of 0.55% [11].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Contrary to popular belief about the uniform spread of schizophrenia around the world, there is a variation in the incidence on a global scale [77], within individual countries [78], and at lower levels , all the way to urban areas [79].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

One of the most persistent findings is the increased incidence of schizophrenia in urban settings: the correlation persists even with the control of possible confusing factors, such as drug addiction, ethnic differences and size of social groups [80].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

According to most anthropologists, schizophrenia is not common among traditional societies and is a disease of civilization [81].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

J.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Devereaux called schizophrenia “an ethnic psychosis of the Western world” [81].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Etiology (causes of the disease)


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The causes and mechanisms of schizophrenia, previously completely unknown [82], have recently begun to be revealed [83] due to advances in neuroscience, but still remain unclear and confusing.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Genetic predisposition, early childhood living conditions, neurobiological disorders, hypothetical data obtained in studies are important pathogenic factors, psychological and social interactions.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Currently, the neurobiological mechanisms of the disease are being actively studied, but a single organic cause has not yet been established.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Although low diagnostic reliability poses problems in calculating the relative contribution of genetic variations and environmental influences (for example, severe bipolar disorder can symptoms overlap with clinical depression), evidence has been obtained that the disease can be caused by a combination of these two groups of factors [84].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

These data suggest that the diagnosis is largely due to heredity, but the onset of the disease significantly depends on environmental factors and stressors [85].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The idea that some people have an innate predisposition (“diathesis”), which manifests itself under the influence of biological, psychological or environmental stressors, is called” stress diathesis model” [86].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The idea of the importance of biological, psychological and social factors was embodied in the concept of a “biopsychosocial model”.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Genetics


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Since it is difficult to separate the contribution of genetic factors from environmental influences, numerical estimates usually vary, but twin studies indicate a high degree of hereditary causation of the disease [88].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Presumably, inheritance is complex, with the possible interaction of several genes, increasing the risk to a critical value or causing several pathological processes, forming a single diagnosis [89] [90].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Studies point to the nonspecificity of detected genes at risk for schizophrenia: they can increase the likelihood of developing other psychotic diseases, such as bipolar disorder [91] [92].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Twin studies have been criticized for a number of methodological problems and errors [93].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

According to data obtained in 2008, rare deletions and duplications of DNA sequences (see variation in the number of copies) are also associated with an increased risk of developing schizophrenia [94].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

There is also evidence of a possible relationship between RELN [95] gene polymorphisms and its expression level [96] with schizophrenia.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

In half of the cases of genetically determined schizophrenia, random mutations that are absent in the genes of the patient's parents are to blame [97].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Prenatal factors


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

It is believed that at an early stage of neuronal development, including during pregnancy, causative factors can interact, leading to an increased risk of future development of the disease.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

In this regard, the discovered dependence of the risk of schizophrenia on the birth season is interesting: the disease is more common in those born in winter and spring (at least in the northern hemisphere) [98].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Evidence has been obtained that prenatal (prenatal) infections increase the risk, and this is another confirmation of the association of the disease with intrauterine developmental disorders [99].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

There is also a hypothesis about an epigenetic predisposition to schizophrenia due to the low level of acylation of certain areas of histones [100] and DNA methylation.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The possibility of correcting these disorders through epigenetic therapy is discussed [101].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Social factors


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

There is a strong correlation between the risk of schizophrenia and the degree of urbanization of the area [80] [102].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Another risk factor is low social status, including poverty [103] and migration due to social tensions, racial discrimination, family troubles, unemployment, poor conditions residence [104], social isolation [105].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Childhood bullying and traumatic experiences also appear as an incentive for the future development of schizophrenia [106] [107]: studies have shown that people diagnosed with schizophrenia are more likely to have experienced physical or emotional abuse, sexual abuse, inadequate physical and emotional treatment in childhood than others; many of them have experienced the loss of parents, abandonment .


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

People diagnosed with schizophrenia who have experienced physical or sexual abuse in childhood are more likely than others with the same diagnosis to have commenting voices or visual hallucinations.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The role of re-traumatization in adulthood is also noted: often the impetus for the development of schizophrenic symptoms is a traumatic experience (for example, sexual violence), similar to traumatic experiences experienced in childhood; however, any trauma, including hospitalization or even the very experience of psychotic symptoms, can revive painful experiences [108].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

It is believed that parental education does not affect the risk, but broken relationships, which are characterized by a lack of support, can contribute [109] [110].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

However, there are many studies that have studied the relationship between communication patterns in the family and the onset of schizophrenia (as well as the risk of relapse).


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

It is shown that such factors as hostility and criticism towards the “patient”, imposition of guilt, excessive emotional interference (excessive guardianship and interference, excessive praise, self-sacrifice, etc.), anomaly in communication (difficulty trying to understand the general meaning of the conversation), intolerance, lack of empathy and lack of flexibility among parents.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

However, it would be too simplistic to reduce all these problems to a unidirectional causal model of accusing parents, since the relationship between communication disorders in the family and the development of symptoms the disease is much more complicated.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Just as impaired communication can cause symptoms, and vice versa [111].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Loneliness is also a social risk factor for schizophrenia [109] [112].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Drug addiction and alcoholism


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Schizophrenia and drug addiction have a complex relationship that makes it difficult to track causation easily.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Convincing evidence suggests that in some people, certain drugs can cause illness or trigger another attack.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

However, it is also possible that patients use psychoactive substances in an attempt to overcome negative feelings associated with both the effect of antipsychotics and the disease itself, key signs which is considered negative emotions, paranoia and anhedonia, because it is known that depression and stress reduce dopamine levels [113] [114].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Amphetamines and alcohol stimulate the release of dopamine [115] [116], and excessive dopaminergic activity at least partially causes psychotic symptoms in schizophrenia.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Various studies have shown that amphetamines increase the concentration of dopamine in the synaptic space, increasing the response of the postsynaptic neuron [117].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

An additional argument is the proven fact of exacerbation of symptoms of schizophrenia under the influence of amphetamines [118].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

However, the use of amphetamines may reduce negative symptoms [119].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

In patients with schizophrenia in remission, psychostimulants have a mild stimulating effect (they increase psychotic symptoms in schizophrenia only during a psychotic episode) [120].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Schizophrenia can be triggered by excessive use of hallucinogenic and other psychoactive substances [121].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

One study suggests the possible role of cannabis in the development of psychosis, but the authors suspect that the proportional effect of this factor is small [122].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Psychological factors


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Many psychological mechanisms were considered as possible causes for the development of schizophrenia and the maintenance of this condition.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Cognitive biases found in patients and individuals at risk, especially under stress or in confusing situations, include excessive attention to possible threats, hasty conclusions, a tendency to external attribution, a distorted perception of the social situation and mental states, difficulties in distinguishing between internal and external speech, and problems with low-level processing of visual information and concentration [123] [124] [125] [126].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Some of these cognitive features may reflect general neurocognitive impairment of memory, attention, problem solving, executive functions and social cognition, others may be related to specific problems and experiences [109] [127].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Despite the typical “smoothness of affect”, recent studies show that many people diagnosed with schizophrenia react very emotionally, especially to stressful and negative stimuli, and that such sensitivity may lead to a predisposition to the manifestation of symptoms of schizophrenia and the development of the disease itself [58] [128] [129].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

There is reason to believe that the content of delusions and psychotic experiences may reflect the emotional causes of the disease, and that the nature of a person's interpretation of these experiences can have effect on symptomatology [130] [131] [132] [133].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Perhaps the development of “safe habits” in behavior in order to avoid imaginary threats contributes to the preservation of chronic delusions [134].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The method of obtaining additional information about psychological mechanisms is to monitor the effect of therapy on symptoms [135].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Neuronal mechanisms


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Neuroimaging using fMRI and PET equipment of the brain in schizophrenia indicates functional differences that most often affect the frontal and temporal lobes, as well as the hippocampus [136].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

These differences are associated with neurocognitive impairment often noted in schizophrenia [137],


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

however, it is difficult to isolate the possible contribution to these disorders associated with antipsychotic drugs, which treated almost all patients who participated in the studies [138].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Patients with schizophrenia also show hypofrontality — a decrease in blood flow to the prefrontal and frontal parts of the cerebral cortex [139] [140].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Dopamine hypothesis


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The dopamine (aka catecholamine [141]) hypothesis pays special attention to dopaminergic activity in the mesolimbic pathway of the brain.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Research in this direction was associated with the discovery of the antipsychotic effect of the first neuroleptics, the most important pharmacological effect of which was the blockade of dopamine receptors.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Various studies have shown that many patients with schizophrenia have increased levels of dopamine and serotonin in some parts of the brain [142] [143] [144].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

These neurotransmitters are part of the so-called “incentive system” and are produced in large quantities during pleasant experiences like sex, drugs, alcohol, delicious food [145].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Neurobiological experiments confirm that even memories of positive encouragement [146]


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

or its anticipation [147]


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

can increase the level of dopamine, which is “used” by the brain for assessment and motivation, consolidating actions important for survival and continuation [148].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The so-called “dopamine theory of schizophrenia” or “dopamine hypothesis” has been put forward; according to one version, patients with schizophrenia learn to enjoy themselves by concentrating on thoughts, causing the release of dopamine and thus overexerting their “reward system”, the damage to which causes the symptoms of the disease.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

There are several different trends among supporters of the “dopamine hypothesis” [142], but in general, it associates the productive symptoms of schizophrenia with disorders in the dopamine systems of the brain.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The “dopamine theory” was very popular, but its influence has weakened in our time, and now many psychiatrists and researchers of schizophrenia do not support this theory, considering it too simplistic and unable to give a full explanation of schizophrenia [142].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

This revision was partly facilitated by the emergence of new (“atypical”) antipsychotics [149],


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

which, with similar efficacy to old drugs, have a different spectrum of effects on neurotransmitter receptors [150].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The primary defect in dopaminergic transmission in schizophrenia could not be established, since researchers obtained different results during the functional assessment of the dopaminergic system.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The results of determining the level of dopamine and its metabolites


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

in blood, urine and cerebrospinal fluid were unconvincing due to the large volume of these biological media, which neutralized possible changes associated with limited dysfunction dopaminergic system [28].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Kinuren hypothesis


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The interest of researchers was also attracted by the neurotransmitter glutamate and the reduced glutamatergic signaling activity of NMDA receptors in schizophrenia.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

This is primarily evidenced by inadequately low levels of glutamate receptors in postmortem analysis of the brain of patients [151] and the fact that drugs that block glutamate activity, such as phencyclidine and ketamine, cause schizophrenic-like symptoms and cognitive impairment [152].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Kinuren acid, an endogenous antagonist of NMDA receptors, attracted special attention, as an increase in its concentration in tick-borne encephalitis causes symptoms similar to those of schizophrenia [153] [154] [ 155].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The fact that a decrease in glutamatergic activity worsens performance in tests requiring frontal lobe and hippocampal activity, as well as the fact that glutamate can affect the dopaminergic system, and both systems are associated with schizophrenia, speaks in favor of the hypothesis about the important intermediary (and possibly determining) role of glutamate signaling pathways in the development of the disease [156].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Additional confirmation of the “kinuren hypothesis” was preliminary data from clinical trials, indicating the possible effectiveness of NMDA receptor coagonists in mitigating some positive symptoms of schizophrenia [157].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Other neurochemical hypotheses


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The possible role of disorders in the GABergic and cholinergic neurotransmitter systems was also noted, which may be partially responsible for the development of negative symptoms at the cortical level and cognitive deficits.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Nevertheless, none of the neurochemical hypotheses can fully explain the variety of symptoms and course of schizophrenia [158].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Structural changes


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

A number of differences were found in the structure and size of some brain areas in schizophrenia [159], starting with an increase in the ventricles of the brain in patients with the most pronounced negative symptoms [160], which shows a significant degradation of gray matter in this disease.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

However, the pathological nature of these structural changes is unclear; there is no direct evidence of the neurotoxicity of psychosis [25].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

It is possible that regularly detected structural changes, primarily in patients with severe forms of the disease and after a long course, may be associated with secondary processes, for example, arise as a result of social isolation and style changes, or as a result of massive pharmacotherapy [158].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Thus, according to some studies, long-term treatment with antipsychotic drugs can make undesirable changes in the structure of the brain [161] [162].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

It has also been shown that alcohol consumption, smoking, cannabis use, and a sedentary lifestyle contribute to the loss of brain volume [25].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Structural changes are noted not only in patients with schizophrenia, but also in some people suffering from affective disorders (ventricular expansion; flattening of the furrows, indicating a decrease in cortical mass) [163], alcoholism and many other diseases [164].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

It is also suggested that these structural changes may occur due to exogenous factors (chronic stress phenomena, infections, toxic effects, etc.) and disorders development (dysontogenesis), including in the perinatal period: for example, impaired proliferation and migration of neurons to the cerebral cortex or natural apoptosis of nerve cells during development [158] .


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

There is evidence that structural changes in patients with schizophrenia are partially reversible.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

In particular, physical activity leads to an increase in the volume of the hippocampus in patients with schizophrenia [25].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Therapy and support


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The concept of a cure for schizophrenia itself remains a subject of controversy, as there is no generally accepted definition of the concept, although rational criteria have been proposed in recent years remission [165],


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

easily applicable in research and clinical practice that can become consensus [166] [167],


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

and there are standardized assessment methods, of which the PANSS scale is generally accepted [168].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Correcting symptoms and increasing the level of functioning appear to be more realistic goals than complete healing.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Revolutionary changes in therapy in the 1950s were associated with the introduction of chlorpromazine [169].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

There is now increasing recognition of a recovery model that emphasizes hope for improvement, empowerment and social integration [170].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Most patients with schizophrenia can be treated on an outpatient basis most of the time.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Even in the acute period of the disease, outpatient treatment is often possible.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The benefits of outpatient and inpatient treatment must be carefully weighed before a decision is made [26].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Hospitalization may be required for severe episodes of schizophrenia.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

It may be voluntary or, if local mental health legislation so permits, involuntary (civil transmission).


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

In Russia, involuntary hospitalization is regulated by the Law on Psychiatric Care.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

A number of other countries have undergone deinstitutionalization, which has made it rare to stay in the hospital for a long time, although it is still possible [31].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Admission to or instead of hospital is followed by support, including open visit centers, visits by district mental health teams or home assertive therapy teams, supported employment [171] and support groups led by patients themselves.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

In many countries outside the Western world, local communities may have the final say in therapy and treatment may be less formal.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

In fact, treatment results may be better in these countries than in the West [172].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The reasons for such statistics are unclear, and cross-cultural studies are currently being conducted to clarify them.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Drug treatment


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The predisposition to schizophrenia is presumably associated with the low level of acetylation of certain histone areas [100], as well as DNA methylation.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

To correct these disorders, drugs based on histone deacetylases can be used [101].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Even if this technique does not completely cure schizophrenia, epigenetic therapy can significantly improve quality of life.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

According to the dopamine hypothesis, people suffering from schizophrenia show increased dopaminergic activity in the mesolimbic pathway [173]


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

and decreased in mesocortical [174] [175].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The main treatment for schizophrenia is the use of antipsychotic drugs (neuroleptics) [176], which can lead to a favorable outcome of the disease and improve social functioning , acting on both “negative” and acute [177] and “productive” symptoms of psychosis and prevent its further development.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

When most antipsychotics are taken, the maximum therapeutic effect is achieved within 7-14 days.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

At the same time, antipsychotics fail to significantly improve negative symptoms and cognitive dysfunction.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

[178] [179] The effect of antipsychotics is primarily due to the suppression of dopamine activity, despite their significant side effects.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The current dosage of antipsychotics is generally lower compared to the first decades of their use.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Despite the widespread prevalence of antipsychotic pharmacotherapy, it is in no way etiopathogenetic, but is a symptomatic therapy focused mainly for low-specific productive symptoms [158].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

It is believed that atypical neuroleptics also act on negative symptoms, while “classical” ones can cause deficiency symptoms themselves.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Symptoms respond to pharmacotherapy to varying degrees.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The American Psychiatric Association generally recommends atypical antipsychotics as a first-line treatment for most patients, but notes that therapy should be individualized optimized for each patient [180].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

There is evidence that clozapine, amisulpride, olanzapine and risperidone are the most effective agents [181].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Further (after relief of psychosis) the use of these antipsychotics can reduce the risk of relapse [182] [183].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

When using antipsychotics, a good response is observed in 40-50% of patients, partial in 30-40%, and 20% show resistance to treatment (no satisfactory response to two or three drugs after six weeks of taking them) [178].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

In such cases of “resistant schizophrenia”, [184] [185] patients are advised to prescribe clozapine, [186] a drug that is highly effective, but carries the risk of potentially fatal side effects, including agranulocytosis and myocarditis in 4% of patients [187] [188].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Clozapine is the only proven drug for resistant schizophrenia (up to 50% efficacy) [15] for those who did not have a therapeutic response to other antipsychotics [189].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Clozapine may also have an additional advantage, presumably reducing the tendency to alcoholism, drug addiction and suicide in patients with schizophrenia [190].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

By inhibiting bone marrow development, clozapine reduces white blood cell levels, which can lead to infection, so when using this drug, a regular blood test is performed in the first six months [191].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

There is uncertainty about how rational it is to prescribe neuroleptics at the first sign of schizophrenia.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

On the one hand, their use at the earliest stages of the disease increases the effectiveness of treatment; however, it is associated with an increased risk of side effects.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Currently available research data do not provide an obvious answer to this question, although practical guidelines [192] in many countries clearly recommend drug therapy neuroleptics for 6—24 months at the first attacks of the disease [193].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

All antipsychotics block dopamine D2 receptors, and the degree of blocking other significant neurotransmitter receptors by them varies [150].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Many of the typical neuroleptics suppress only D2 receptors, and most atypical ones simultaneously affect a number of neurotransmitter receptors: dopamine, serotonin, histamine and others [150].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Despite the higher cost, atypical antipsychotics are still preferable at the initial choice of therapy to older, “typical” ones: they are usually easier to tolerate and use is less likely to be accompanied by late dyskinesia, although they are more likely to cause weight gain and diseases associated with obesity, especially risperidone and quetiapine, as well as olanzapine, whose use is associated with high risk of diabetes and metabolic syndrome [181] [194].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Also, people receiving atypical antipsychotics have cases of increased levels of prolactin, galactorrhea and pituitary tumors [195] [196].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

It remains unclear whether switching to newer drugs reduces the chances of developing neuroleptic malignant syndrome, a rare but severe and potentially fatal neurological disorder most often occurring as a negative reaction to antipsychotics [197].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Both classes of antipsychotics are generally believed to be equally effective in suppressing positive symptoms of the disease.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Some researchers have suggested that atypical drugs provide additional benefits in addressing the negative and cognitive symptoms of schizophrenia, but the clinical significance of these effects is not yet is installed.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Recent works refute the statement about a reduced incidence of extrapyramidal side effects when using atypical antipsychotics, especially when their old analogues are selected in small doses or low-potent typical antipsychotics are used [198].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

According to prospective longitudinal 15- and 20-year studies (Martin Harrow et al., 2007, 2012), not all patients with schizophrenia are shown lifelong neuroleptics.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

It was found that patients who stopped taking antipsychotics demonstrated a higher level of neurocognitive skills in the long term compared to those who continued taking it.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

They were also less vulnerable to anxiety disorders and recurrent psychosis, demonstrating longer periods of remission.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Permanent blockade of dopamine D2 receptors can lead to a compensatory increase in their density and affinity, presumably the consequence of these changes is an increased risk of recurrence of psychosis (see Fig. . Hypersensitivity psychoses), and larger doses of antipsychotics are required to block the increased number of dopamine receptors [199].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Care should be taken when prescribing high doses of neuroleptics, since excessive blocking of dopamine receptors, which is responsible for good mood, can cause bouts of depression, which, in in turn, can increase dependent behavior of patients who sometimes try to compensate for the lack of dopamine effects with drugs and alcohol (since amphetamines stimulate the release of dopamine) [200 ].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

There is also a problem of non-compliance with doctor's instructions: about half of outpatients deliberately violate medical instructions [201].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

For patients who do not want or are unable to take pills regularly, prolonged forms of drugs have been developed, which should be injected every two weeks.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

In the United States and Australia, legislation makes it possible to force such injections to patients who refuse to take short-term forms of drugs, but at the same time are in a stable condition and are not impeding the normal life of others.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Reducing doses of neuroleptics during maintenance treatment can reduce the severity of side effects, but increases the risk of exacerbation, as well as their abrupt cancellation.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

In patients with the first psychotic episode, short-term use of small doses of neuroleptics is associated with a more favorable prognosis [199].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

There is evidence that in the long run, some patients are better off without taking antipsychotics [202].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

One of the most acute problems of modern psychiatry is the unreasonably frequent use of combinations of neuroleptics (polypharmacy).


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

It is much more effective and much safer to prescribe not two or more neuroleptics, but the combination of neuroleptics with drugs of a different mechanism of action - benzodiazepines or normotimics- anticonvulsants (valproates, lamotrigine, etc.) [203].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Despite the encouraging results of early pilot studies [204], omega-3-unsaturated fatty acids do not lead to an improvement in symptoms, according to a meta-analysis [205].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Supplementary therapy


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

In resistant schizophrenia, clozapine is recommended [189].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

If this does not help, a strategy is used to add other drugs to clozapine [206] [207].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Of the antipsychotics, clozapine is combined with amisulpride, risperidone, and with negative symptoms with aripiprazole.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Of the antidepressants, citalopram, fluvoxamine, mirtazapine are added to clozapine, with which clozapine acts on the negative symptoms of schizophrenia, which are considered the most difficult to treat.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Lamotrigine, topiramate, valproic acid are used from anticonvulsants.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

As well as memantine, which gives a significant improvement, confirmed statistically, [208] [209].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Other antipsychotics for negative symptoms are also used together with fluoxetine, mirtazapine, omega-3 [210], serine.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

With global symptoms together with donepezil, sarcosine [211] [212] [213] [214] [215].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

In case of aggression, antipsychotics together with S-Adenosylmethionine [216].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The addition of rivastigmine improves memory, selective attention and integration of information with knowledge and its context in patients with schizophrenia, and galantamine attention and memory, and can also have an auxiliary therapeutic effect, including negative symptoms and apathy among patients with chronic schizophrenia and residual symptoms [217] [218].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Psychological and social therapy


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Psychotherapy is also widely recommended and used for schizophrenia, although therapy is sometimes limited by pharmacology due to funding problems or insufficient training of personnel [219].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

In addition to treating the disease itself, it (psychotherapy) is also aimed at the social and professional rehabilitation of patients.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Only antipsychotic drugs themselves do not allow restoring the patient's condition to a premorbid level of functioning in society, and psychotherapy, family and individual, allowing affect social factors and patient adaptation, can significantly determine the outcome of the disease [220] :408.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Cognitive behavioral therapy (CBT) is used to alleviate symptoms and improve related aspects — self-esteem, social functioning and awareness of one's condition; reducing distress experienced by patients suffering from psychosis and improving their quality of life.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

CBT in psychosis is focused not so much on eliminating psychotic symptoms, but on helping patients develop a system of psychotic experiences that would allow them to avoid serious suffering [221].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Although early tests did not give a clear result [222],


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

subsequent reviews indicate the possible effectiveness of CBT in addressing symptoms of schizophrenia [223] [224].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

There is a meta-analysis showing the effectiveness of CBT in individuals diagnosed with schizophrenia; according to the findings of the meta-analysis, CBT should be offered as part of routine treatment patients.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Some studies have shown the superiority of CBT over supportive psychotherapy for psychosis [221].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

In addition, it was concluded that CBT can slightly reduce the relapse rate in patients [224].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Data on psychoanalytic treatments for schizophrenia are contradictory, and the effectiveness of these methods is one of the most controversial topics in psychiatry.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Many specialists take the position of complete rejection of the use of psychoanalysis in people with schizophrenia.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

There is evidence both in favor of psychoanalytic therapy versus drug therapy; a number of reviews conclude that there is too little data on efficacy psychoanalysis.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

However, one meta-analysis showed that both psychoanalytic therapy and cognitive-behavioral therapy, even in cases where either of these treatments is used without medication, are as effective as and traditional antipsychotic therapy.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

This gives hope that psychotherapy, used on its own, without medication, can be a suitable treatment for patients who do not benefit from antipsychotics or those who refuse them take, or those who are being treated by a doctor who prefers to use only a small amount of medication or not use it at all [225].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

One of the arguments against individual psychotherapy (both cognitive-behavioral and psychoanalytic) is its high cost.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Nevertheless, according to supporters of the use of psychotherapy for psychosis, the total cost of its use is lower than with the use of neuroleptics, since in this case the patient is less is treated inpatient, functions at a higher level, and his mental problems do not interfere with finding and maintaining a job as much as the mental problems of those who are exposed to medication treatment [225].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Another approach is cognitive training (English: cognitive remediation therapy), which is aimed at combating cognitive impairment that is sometimes present in schizophrenia.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The first results indicate the cognitive effectiveness of this area, based on methods of neuropsychological rehabilitation, and some positive developments are accompanied by changes the nature of brain activation noted during FMRI scanning [226].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

A similar approach called “cognitive improvement therapy”, aimed, in addition to the neurocognitive sphere, at social cognition, has also shown effectiveness [227].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Family therapy or training, approaches that generally target the family system of which the patient is a part are generally found useful in studies, at least for long-term intervention [228] [229] [230].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Psychotherapeutic counseling of the patient's family, having a positive effect on family relations, helps to eliminate problems in relationships and thus facilitates the outcome of the disease [220] :408.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Since family relationship problems are often a risk factor for relapse, family therapy can reduce the risk of relapse by teaching parents communication skills and stress management, the fact that criticism, invasion and hyper-protection are excluded, or the number of contacts between parents and patients decreases.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

There are various options for family therapy, such as psychoanalytic family therapy, systemic family therapy, but the treatment program must always be adapted to the needs specific family and is focused on a constructive open dialogue, during which solutions to the problems experienced are jointly developed [231].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

In addition to the therapy itself, recognition is given to the serious impact of the disease on the family and the heavy burden that falls on the shoulders of those who care for the patient, and therefore more “self-help books” are published on this topic [232] [233].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Some evidence suggests the benefits of teaching social skills, but there have been significant negative results in this direction [234] [235].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Some works consider the possible benefits of music therapy and other creative forms of therapy [236] [237] [238], however, according to other sources, art therapy has shown ineffective results in treatment schizophrenia [239].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Mental health clients' movements have become an integral part of the recovery process in Europe and America; groups such as the Hearing Voices Network and the Paranoia Network have developed Self-help techniques aimed at providing support and care beyond the traditional medical model adopted by most psychiatrists.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

By avoiding considering personal experience in terms of mental illness or mental health, they seek to destigmatize these experiences and inspire the person to take personal responsibility and gaining a positive self-perception.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Partnerships are increasingly being established between hospitals and patient organizations, while the work of doctors contributes to the return of people to society, their development of social skills and reduce re-hospitalization rates [240].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

As an alternative to a rigid system of psychiatric institutions, where people are often perceived as authoritarian, unfriendly or cruel, and treatment is reduced to regular use psychiatric (in particular, antipsychotic) drugs, are considered Soteria Houses, named after the name of the first Soteria House created by Laurent Mosher [241] [242].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Soteria houses or Soteria houses are currently operating in Sweden, Finland, Germany, Switzerland, Hungary and some other countries [243].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

In his 1999 work Soteria and Other Alternatives to Emergency Psychiatric Hospitalization, Lauren Mosher, who developed the Soteria method, described it as “24 hours a day use interpersonal phenomenological interventions carried out by non - professional personnel, usually without treatment with neuroleptic drugs, in the context of a small, supportive, protective and tolerant social environment” [244].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The results of the studies are scarce, but their systematic review in 2008 showed that the program is similar in effectiveness to treatment with neuroleptics in the first and second episodes of schizophrenia [245].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Other methods


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Electroconvulsive therapy (ECT) is not considered at the initial choice of therapy strategy, but may be prescribed if other methods fail.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

It is more effective in the presence of symptoms of catatonia [246], and NICE in the UK recommends ECT for catatonia if the patient has already had it successfully, but others There are no recommendations for ECT in schizophrenia [247].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Psychosurgery has become rare nowadays and is not recommended for schizophrenia [248].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Insulin coma therapy for the treatment of schizophrenia has been used in the West from its inception in the 1930s until the 1950s, when it was recognized that there was no evidence of its effectiveness, despite the fact that it is significantly more dangerous than ECT [249].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

In Russia, insulin coma therapy continues to be used, representing, from the point of view of a number of specialists, a unique method of therapy [250].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Atropinocomatous therapy is also sometimes used.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Prediction


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Course of the disease


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

As part of the International Study of Schizophrenia (ISOs), coordinated by WHO, 1,633 patients from different countries with a diagnosis of schizophrenia.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

After 10 and 15 years, different results were noted both for countries and for subjects.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Overall, more than half of the patients available for long-term records have recovered (English: recovered) in terms of symptomatology (4 on the Bleuler Scale) and more than a third were considered to have recovered if take into account, in addition to symptoms, the level of functioning (above 60 on the GAF scale).


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Approximately a sixth of them “were found to have achieved full recovery requiring no more therapy in any form”, although some still showed isolated symptoms and a decrease ability to work.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

A significant number had “late recovery”, even after chronic problems and failures in the selection of therapy.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The findings state that “the results of the IsoS project, along with other similar data, are helping to rid patients, caregivers, and clinicians of the paradigm chronic course that dominated ideas about the disease for most of the 20th century” [23].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

A review of major longitudinal studies conducted in North America also shows a large variation in results, as well as the fact that the course of the disease can be mild, moderate, or severe.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The clinical outcome was on average worse than in other psychotic and psychiatric disorders, but between 21% and 57% of patients, depending on the severity of the criteria, showed good results.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Progressive deterioration was observed “in a small number of cases”, although both the risk of suicide and early mortality were noted.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The authors note that “the most important is the evidence obtained that in a moderate number of cases, patients demonstrate complete remission of symptoms without subsequent relapses, at least for a long time, and that some of these patients do not require supportive drug therapy” [24].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Clinical study with strict recovery criteria (simultaneous remission of positive and negative symptoms with adequate social and professional functioning for two years) indicates a 14 per cent recovery within the first five years [251].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

In another study, which took into account patients living in the same area, 62% of the subjects showed an overall improvement according to the composite index of symptoms, clinical and functional indicators [252].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Another longitudinal study, which lasted more than 20 years, found that at least half of the 1,300 people with schizophrenia achieved “recovery or significant improvement” [27] :150.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

When analyzing WHO data, another important pattern was found: people diagnosed with schizophrenia living in “developing countries” (India, Colombia, Nigeria) show the best long-term indicators compared to patients from “developed countries” (USA, Great Britain, Ireland, Denmark, Czech Republic, Slovakia, Japan, Russia) [253], despite the fact that antipsychotic drugs, as a rule, are less are available in poor countries.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Determining recovery


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The statistical results of the studies vary due to the lack of generally accepted strict definitions of remission and recovery.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The “Schizophrenia Remission Working Group” proposed standardized criteria for remission, including “improvement in underlying signs and symptoms to a level at which any residual symptoms are so mild that they no longer have a significant effect on behavior and do not reach the threshold determining the initial diagnosis of schizophrenia” [254].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Some researchers have put forward standardized criteria for recovery, indicating that the DSM-IV definitions of “complete return to premorbid (pre - illness) level of functioning” or “perfect return to full functioning” are inadequate, not measurable, incompatible with the range of variations recognized in society as the norm of psychosocial functioning, and contribute to stigma and create a vicious circle of pessimism [255].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Between people diagnosed with schizophrenia, including those in the “consumer/victim” movements, and some mental health professionals, there may be quite strong disagreements regarding basic attitudes and concepts of recovery [256].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Among the noticeable limitations inherent in almost all research criteria is lack of attention to how the subject himself assesses his condition and feels in life.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Illness and subsequent recovery often involve prolonged self-frustration, isolation from friends and family, disruption of education and career, and social stigmatization, which cannot simply be reversed or forgotten” [170].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

A model that defines recovery as a process similar to the gradual “avoidance” of problems related to drugs and alcohol is gaining weight, and emphasizes the uniqueness of the path of everyone who has embarked on this the way in search of hope, freedom of choice, new opportunities, inclusion in society, achievements [170].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Forecast indicators


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Several factors correlate with a more positive overall prognosis: female sex, acute onset (sharp onset of symptoms as opposed to gradual), greater age at the first episode, predominance positive (as opposed to negative) symptoms, the presence of mood disorders, a good level of functioning before illness [29] [30], ability to work well, academic success, social skills, favorable economic conditions, low family connectivity with medical prescriptions [257].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The strengths of character and the availability of internal resources, manifested in determination and “psychological resilience”, are also associated with a better forecast [24].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Acceptance and support from loved ones and acquaintances can significantly affect the outcome of the disease.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Studies have shown that the negative aspects of the attitude of others — the number of critical comments, the level of hostility and the disposition to invade and control someone else's life (together —” expressed emotions”, using the terminology of researchers) — all this is accompanied by an increased risk of relapse over and over again [258].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

On the other hand, most of these studies only speak of correlation, and it is often difficult to establish the direction of cause-effect relationships.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Frequent or prolonged (recurrent) hallucinations are closely related to a negative prognosis, in addition, they have a bad effect on employment opportunities for patients, preventing them from returning to normal life [55].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Isolation of patients and their prolonged stay in old-style hospitals, which lead to the development of hospitalism, also predisposes to an unfavorable prognosis (the formation of residual conditions) [26].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Mortality rate


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

When analyzing data on more than 168,000 Swedish citizens receiving psychiatric treatment, the life expectancy of patients with schizophrenia was about 80% — 85% of the average.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Women diagnosed with schizophrenia lived slightly longer than men, and in general, the disease was associated with longer life expectancy than alcoholism and drug addiction, personality disorders, heart attacks and strokes [259].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Schizophrenia has an increased risk of suicide (according to Soviet-era data, among patients diagnosed with schizophrenia who were registered with a psychoneurological dispensary, suicidal the risk was 32 times higher than in the general population; in manic depressive psychosis, the same figure was 48, and in reactive depression it was 100) [260]; a recent study suggests that 30 % of patients have attempted suicide at least once in their lives [261] [262].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

According to another study, over the 20-year period of illness, about 50% of people with schizophrenia attempted suicide, with 10% of them completed [263].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Another study suggests a 10% suicide mortality rate for schizophrenia [264].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Additionally, factors such as smoking, poor diet, lack of exercise and the negative effects of psychotropic drugs are indicated [21].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

According to studies, the use of neuroleptics is associated with a higher mortality rate than in the population, and the relationship between the number of neuroleptics taken and its level is statistically reliable (with polytherapy, the risk of premature mortality increases).


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The use of antipsychotics leads to cardiovascular and pulmonary disorders, which at least partially explains the increased risk of mortality [265].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

A large study (Ray et al., 2001) showed that taking neuroleptics is associated with an increased risk of sudden cardiac death [266].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Some of the side effects of antipsychotics can lead to an increased risk of suicide — for example, DSM-IV notes that “akathisia may be associated with dysphoria, irritability, aggression or suicide attempts” [267].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

In placebo-controlled trials, there was a statistically significant increase in the number of completed suicides against the background of active treatment with neuroleptics [268].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

A cohort study of 247,858 children and young adults found a significantly increased risk of sudden death in patients taking higher doses of neuroleptics than in the control group [269].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

In 2006, the British Journal of Psychiatry published data from a study by the authors of which (M. Joukamaa, M. Helliovaara, P. Knekt, etc.), having studied a 17-year catamnesis of more than 7 thousand patients with diagnosed with schizophrenia, it was found that during this period, 35, 44 and 57% of patients who received one, two, three or more classical (typical) neuroleptics died, respectively, while among patients with this diagnosis who did not receive classical neuroleptics, the same indicator was only 5% [203].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

violence


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The link between acts of violence and illness is a topic for debate.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Modern works say that the percentage of patients with schizophrenia who resort to violence is higher than the percentage of people without any diseases, but at the same time lower than with disorders of similar alcoholism, and that the difference is smoothed out or completely disappears during district consideration, taking into account factors related to the disease, primarily socio-demographic variables, alcoholism and drug addiction [270 ] [271] [272] [273] [274].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Studies show that 5% to 10% of murder charges in Western countries are made to people suffering from schizophrenic spectrum disorders [275] [276] [277].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Psychosis in schizophrenia is sometimes associated with an increased risk of acts of violence.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Studies of the specific contribution of delusions and hallucinations do not give an unambiguous picture, primarily paying attention to the delirium of jealousy, the feeling of threat, and commanding voices.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

It has been suggested that patients of a certain type are more prone to violence, who are characterized by learning problems, low IQ, behavioral disorders, early alcoholism and drug addiction, violations of law and order before diagnosis [275].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Consistent data show that people diagnosed with schizophrenia are more likely to be victims of violent crime — at least 14 times more likely than perpetrators [278] [279].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

In the small part of patients who commit violent acts, there is persistent abuse of psychoactive substances, primarily alcohol [280].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Aggression, both on the part of patients and directed against them, usually occurs in the context of complex social interactions in the family [281], and is also a problem in the clinic [282] and locally of the patient's residence [283].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Screening and prevention


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Currently, there are no reliable markers that can predict the development of schizophrenia, but studies are underway that assess the possibility of determining a future diagnosis by a combination genetic factors and psychosic-like experiences that do not lead to a decrease in the functional level [284].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

People who meet the criteria of 'ultra high-risk state', which implies transient or self-controlled psychotic experiences against the background of a family history of schizophrenia, during the year with a probability of 20-40%, they receive the same diagnosis [285].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

It has been shown that various methods of psychotherapy and medications can reduce the chances of developing real schizophrenia in individuals who meet the 'high risk' criteria [286].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

At the same time, the treatment of people who may never develop schizophrenia is full of contradictions due to the risk of side effects when using antipsychotics, especially potentially disfiguring consequences, such as tardive dyskinesia, as well as rare but sometimes deadly neuroleptic malignant syndrome [287].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

The most common form of preventive activity is educational public campaigns that provide information on risk factors for schizophrenia, early diagnosis and treatment options [288 ].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Criticism and alternative approaches


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Diagnostic problems and disputes


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Criticism of the diagnosis of schizophrenia is related to its lack of scientific validity and reliability [289] [290] [257] and is part of broader criticism aimed at the diagnostic criteria of psychiatry in as a whole.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

An alternative to an arbitrarily established boundary between disease and norm may be to consider individual indicators in various diagnostic measurements, assuming the presence of a spectrum or a continuum of conditions as opposed to an unambiguous diagnosis.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

This approach fits well into the outline of studies of schizotype and is consistent with data on the high frequency of psychotic experiences in the general population [291] [292] and delusional beliefs that often do not cause negative emotions [293].


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

Specialists are increasingly expressing the opinion that schizophrenia is not a disease, but a syndrome, a consensus nosological unit, the sum of terms that ensures communication between doctors general practitioners, psychiatrists and researchers, patients and their relatives.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

In 2002, in the professional journal mGV (article “Exposing Schizophrenia”), Peter de Walmnik (Dutch: Pieter de Valminck) spoke about the harmful consequences of understanding schizophrenia as a disease.


Question: Who is most likely to suffer from neuroleptic malignant syndrome?

schizophrenia

In 2003, during a lecture at the Netherlands Institute of Mental Health and Addictions, he argued against the existing concept of schizophrenia, which in many cases he claims to be harmful.