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Use of Expert Consultation in a Complex Case of Neuroleptic Malignant Syndrome Requiring Electroconvulsive Therapy

WITTENAUER WELSH, JUSTINE MD; JANJUA, A. UMAIR MD; GARLOW, STEVEN J. MD, PhD; MCCORMICK, LAURIE MD; HUSAIN, MUSTAFA M. MD; MAIXNER, DANIEL F. MD; WEINER, RICHARD D. MD, PhD; HERMIDA, ADRIANA P. MD

Journal of Psychiatric Practice: November 2016 - Volume 22 - Issue 6 - p 484–489
doi: 10.1097/PRA.0000000000000193
CLINICAL CASE DISCUSSIONS

Our team at Emory University Hospital contacted experts at the National Network of Depression Centers (NNDC) for clinical guidance concerning a patient with schizophrenia hospitalized in the intensive care unit with a complex case of prolonged delirium secondary to neuroleptic malignant syndrome (NMS). Through the NNDC, leading psychiatrists across the United States with expertise in electroconvulsive therapy (ECT) provided us with treatment strategies based on experience in our area of concern. This report describes our use of ECT to treat severe NMS in this patient with schizophrenia, utilizing the recommendations made by the NNDC’s ECT experts concerning electrode position, number and frequency of treatments, and selection of anesthetic induction agents. This case report highlights the utility of expert consultation in the treatment of rare diseases and provides guidance on how to treat NMS in the intensive care unit setting.

WITTENAUER WELSH, JANJUA, and HERMIDA: Department of Psychiatry and Behavioral Science, Emory University School of Medicine, Atlanta, GA

GARLOW: University of Wisconsin Psychiatric Institute and Clinics, Madison, WI

MCCORMICK: University of the Virgin Islands, St Thomas, VI, and Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA

HUSAIN: Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX and Department of Psychiatry and Behavioral Science, Duke University School of Medicine, Durham, NC

MAIXNER: Department of Psychiatry, University of Michigan Health System, Ann Arbor, MI

WEINER: Department of Psychiatry and Behavioral Science, Duke University School of Medicine, Durham, NC

The authors declare no conflicts of interest.

Please send correspondence to: Justine Wittenauer Welsh, MD, The Emory Clinic, 12 Executive Park Dr NE Suite 200, Atlanta, GA 30329 (e-mail: justine.welsh@emory.edu).

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