{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T01:08:34Z","timestamp":1792112914480,"version":"4.4.0"},"reference-count":32,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2015,1,1]],"date-time":"2015-01-01T00:00:00Z","timestamp":1420070400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Int J Psychiatry Med"],"published-print":{"date-parts":[[2015,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Neuroleptic malignant syndrome (NMS) requires emergency treatment and can be fatal. Combined aripiprazole and clozapine therapy is rarely used in clinical settings, and NMS related this combination still lacks evaluation. Herein, we present two cases of atypical NMS treated with aripiprazole and clozapine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Case 1 was a schizophrenic male with a history of NMS under treatment with aripiprazole 20\u2009mg. He was hospitalized and maintained with aripiprazole 5\u2009mg and clozapine 225\u2009mg. On the 25th day, atypical NMS occurred with rigidity, elevated creatine kinase, and stupor, which subsided with supportive therapy. He was discharged under treatment with aripiprazole 15\u2009mg and fluoxetine 60\u2009mg. Case 2 was a female with schizoaffective disorder without a history of NMS. She was hospitalized and maintained with clozapine 50\u2009mg and aripirazole 30\u2009mg. On the 11th day, atypical NMS occurred with mild fever, delirium, and rigidity, which subsided under supportive therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results and Conclusions<\/jats:title>\n                    <jats:p>Our cases highlight the atypical features of NMS in patients being treated with combined ari-piprazole and clozapine. Consciousness change, modest elevation of creatine kinase, and leukocytosis were the most consistent findings; hyperthermia accounts for only some of the cases. This is a reminder of the importance of earlier detection of the soft signs and atypical features of NMS under this combined treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2190\/pm.49.1.c","type":"journal-article","created":{"date-parts":[[2015,4,7]],"date-time":"2015-04-07T14:37:35Z","timestamp":1428417455000},"page":"35-43","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":15,"title":["Atypical Neuroleptic Malignant Syndrome in Patients Treated with Aripiprazole and Clozapine: A Case-Series Study and Short Review"],"prefix":"10.1177","volume":"49","author":[{"given":"Ping-Tao","family":"Tseng","sequence":"first","affiliation":[{"name":"Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Chung","family":"Chang","sequence":"additional","affiliation":[{"name":"Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chih-Hua","family":"Chang","sequence":"additional","affiliation":[{"name":"Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hung-Yu","family":"Wang","sequence":"additional","affiliation":[{"name":"Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Shian","family":"Cheng","sequence":"additional","affiliation":[{"name":"Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ching-Kuan","family":"Wu","sequence":"additional","affiliation":[{"name":"Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yen-Wen","family":"Chen","sequence":"additional","affiliation":[{"name":"EDa hospital, Kaohsiung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weilun","family":"Chung","sequence":"additional","affiliation":[{"name":"Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2015,2,1]]},"reference":[{"key":"bibr1-PM.49.1.c","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1819.2009.02042.x"},{"key":"bibr2-PM.49.1.c","volume-title":"The neuroleptic malignant syndrome and related condition","author":"Lazarus A","year":"1989"},{"key":"bibr3-PM.49.1.c","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0447.2003.02385.x"},{"key":"bibr4-PM.49.1.c","doi-asserted-by":"publisher","DOI":"10.1176\/ps.49.9.1163"},{"key":"bibr5-PM.49.1.c","volume-title":"Diagnostic and statistical manual of mental disorders","author":"American Psychiatric Association","year":"2000","edition":"4"},{"issue":"4","key":"bibr6-PM.49.1.c","first-page":"530","volume":"28","author":"Picard LS","year":"2008","journal-title":"Phar-macotherapy"},{"key":"bibr7-PM.49.1.c","doi-asserted-by":"publisher","DOI":"10.1002\/pds.1937"},{"key":"bibr8-PM.49.1.c","doi-asserted-by":"publisher","DOI":"10.1016\/j.ncl.2003.12.006"},{"key":"bibr9-PM.49.1.c","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1985.03360190098033"},{"key":"bibr10-PM.49.1.c","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.141.6.796"},{"key":"bibr11-PM.49.1.c","doi-asserted-by":"publisher","DOI":"10.2165\/00003495-200464150-00010"},{"key":"bibr12-PM.49.1.c","doi-asserted-by":"publisher","DOI":"10.1016\/S0014-2999(96)00920-X"},{"key":"bibr13-PM.49.1.c","doi-asserted-by":"publisher","DOI":"10.1016\/S0920-9964(03)00050-1"},{"key":"bibr14-PM.49.1.c","doi-asserted-by":"publisher","DOI":"10.1177\/0269881106068289"},{"key":"bibr15-PM.49.1.c","doi-asserted-by":"publisher","DOI":"10.1016\/j.pnpbp.2008.02.010"},{"key":"bibr16-PM.49.1.c","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.v69n0505"},{"key":"bibr17-PM.49.1.c","doi-asserted-by":"publisher","DOI":"10.1097\/01.chi.0000142277.95052.94"},{"key":"bibr18-PM.49.1.c","doi-asserted-by":"publisher","DOI":"10.1097\/01.jcp.0000195914.36435.81"},{"issue":"7","key":"bibr19-PM.49.1.c","first-page":"435","volume":"99","author":"Rodriguez OP","year":"2006","journal-title":"Journal ofthe Oklahoma State Medical Association"},{"key":"bibr20-PM.49.1.c","doi-asserted-by":"publisher","DOI":"10.1016\/j.pnpbp.2009.12.022"},{"key":"bibr21-PM.49.1.c","doi-asserted-by":"publisher","DOI":"10.1097\/00004714-199910000-00007"},{"key":"bibr22-PM.49.1.c","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2005.05.003"},{"key":"bibr23-PM.49.1.c","doi-asserted-by":"publisher","DOI":"10.2165\/00023210-200923060-00003"},{"key":"bibr24-PM.49.1.c","doi-asserted-by":"publisher","DOI":"10.1111\/j.1744-6163.2003.tb00679.x"},{"key":"bibr25-PM.49.1.c","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.v65n0403"},{"key":"bibr26-PM.49.1.c","author":"Su YP","year":"2013","journal-title":"Acta Psychiatrica Scandinavica"},{"key":"bibr27-PM.49.1.c","doi-asserted-by":"publisher","DOI":"10.1097\/01.jcp.0000426179.81948.3f"},{"key":"bibr28-PM.49.1.c","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2011.07.005"},{"issue":"3","key":"bibr29-PM.49.1.c","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.1016\/S0022-3565(25)11451-1","volume":"260","author":"Fischer V","year":"1992","journal-title":"Journal of Pharmacologic Experimental Therapy"},{"key":"bibr30-PM.49.1.c","doi-asserted-by":"publisher","DOI":"10.1124\/dmd.112.050484"},{"key":"bibr31-PM.49.1.c","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-7843.2007.00017.x"},{"key":"bibr32-PM.49.1.c","doi-asserted-by":"publisher","DOI":"10.1124\/jpet.105.092155"}],"container-title":["The International Journal of Psychiatry in Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.2190\/PM.49.1.c","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.2190\/PM.49.1.c","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.2190\/PM.49.1.c","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T10:14:02Z","timestamp":1777457642000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.2190\/PM.49.1.c"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,1]]},"references-count":32,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2015,1]]}},"alternative-id":["10.2190\/PM.49.1.c"],"URL":"https:\/\/doi.org\/10.2190\/pm.49.1.c","relation":{},"ISSN":["0091-2174","1541-3527"],"issn-type":[{"value":"0091-2174","type":"print"},{"value":"1541-3527","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,1]]}}}