{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T10:20:37Z","timestamp":1782296437053,"version":"3.54.5"},"reference-count":26,"publisher":"American Association of Psychiatric Pharmacists (AAPP)","issue":"1","license":[{"start":{"date-parts":[[2024,2,1]],"date-time":"2024-02-01T00:00:00Z","timestamp":1706745600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"},{"start":{"date-parts":[[2024,2,1]],"date-time":"2024-02-01T00:00:00Z","timestamp":1706745600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n        <jats:sec>\n          <jats:title>Introduction<\/jats:title>\n          <jats:p>Serotonin syndrome and neuroleptic malignant syndrome are caused by 2 distinct pathologies; however, the clinical presentation associated with both syndromes share many features.<\/jats:p>\n        <\/jats:sec>\n        <jats:sec>\n          <jats:title>Methods<\/jats:title>\n          <jats:p>We describe a 56-year-old male patient who presented to our facility with seizures, leukocytosis, fevers, extremity hyperreflexia, and signs of autonomic dysfunction as evidenced by cardiovascular instability. The patient was noted to be taking vortioxetine, trazodone, lamotrigine, lurasidone, and carbidopa-levodopa as outpatient medications for his depression, an unspecified mood disorder, and Parkinson disease. Following a robust workup and failure of other therapies, all serotonergic and dopaminergic medications were held, and the patient was tried on cyproheptadine for serotonin syndrome, which led to the cessation of fevers. Bromocriptine was added to the regimen, which led to the resolution of the remainder of the patient\u2019s symptoms.<\/jats:p>\n        <\/jats:sec>\n        <jats:sec>\n          <jats:title>Results<\/jats:title>\n          <jats:p>The overlapping symptomatology of several key diagnostic criteria for both serotonin syndrome and neuroleptic malignant syndrome as well as their nature as diagnoses of exclusion require an evaluation of the patient\u2019s aggregate improvement following targeted pharmacologic strategies for both syndromes. The efficacy of both cyproheptadine and bromocriptine when administered concomitantly support the concurrent pathologies.<\/jats:p>\n        <\/jats:sec>\n        <jats:sec>\n          <jats:title>Discussion<\/jats:title>\n          <jats:p>Clinicians at the bedside must be cognizant of the potential for clinically relevant drug-drug interactions that may present with overlapping pathologies.<\/jats:p>\n        <\/jats:sec>","DOI":"10.9740\/mhc.2024.02.023","type":"journal-article","created":{"date-parts":[[2024,2,8]],"date-time":"2024-02-08T11:12:19Z","timestamp":1707390739000},"page":"23-27","source":"Crossref","is-referenced-by-count":6,"title":["Serotonin syndrome and neuroleptic malignant syndrome: A case report of intersecting symptomatology"],"prefix":"10.9740","volume":"14","author":[{"given":"Loulwa","family":"Maktabi","sequence":"first","affiliation":[{"name":"Visiting Assistant Clinical Professor & Clinical Pharmacist, The University of Toledo College of Pharmacy and Pharmaceutical Sciences, Toledo, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denver","family":"Shipman","sequence":"additional","affiliation":[{"name":"Clinical Pharmacy Specialist, The Robert J. Dole Veteran Affairs Medical Center, Wichita, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin P.","family":"Reinert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4719","reference":[{"issue":"(2)","key":"i2168-9709-14-1-23-b01","series-title":"Drug Saf","first-page":"197","article-title":"Consensus recommendations for systematic evaluation of drug-drug interaction evidence for clinical decision support","volume":"38","author":"Scheife","year":"2015","unstructured":"Scheife\n              RT\n            ,\nHinesLE,\nBoyceRD,\nChungSP,\nMomperJD,\nSommerCD,\net al.\n          Consensus recommendations for systematic evaluation of drug-drug interaction evidence for clinical decision support.\nDrug Saf.\n2015;\n38(2):\n197\u2013\n206.\nDOI: 10.1007\/s40264-014-0262-8"},{"issue":"(1)","key":"i2168-9709-14-1-23-b02","series-title":"Expert Opin Drug Saf","first-page":"83","article-title":"Epidemiology and characteristics of adverse drug reactions caused by drug\u2013drug interactions","volume":"11","author":"Magro","year":"2012","unstructured":"Magro\n              L\n            ,\nMorettiU,\nLeoneR.\n          Epidemiology and characteristics of adverse drug reactions caused by drug\u2013drug interactions.\nExpert Opin Drug Saf.\n2012;\n11(1):\n83\u2013\n94.\nDOI: 10.1517\/14740338.2012.631910"},{"issue":"(11)","key":"i2168-9709-14-1-23-b03","series-title":"N Engl J Med","first-page":"1112","article-title":"The serotonin syndrome","volume":"352","author":"Boyer","year":"2005","unstructured":"Boyer\n              EW\n            ,\nShannonM.\n          The serotonin syndrome.\nN Engl J Med.\n2005;\n352(11):\n1112\u2013\n20.\nDOI: 10.1056\/NEJMra041867"},{"issue":"(7)","key":"i2168-9709-14-1-23-b04","series-title":"pharmacotherapy","first-page":"894","article-title":"Serotonin syndrome in a child associated with erythromycin and sertraline","volume":"19","author":"Lee","year":"1999","unstructured":"Lee\n              DO\n            ,\nLeeCD.\n          Serotonin syndrome in a child associated with erythromycin and sertraline.\npharmacotherapy.\n1999;\n19(7):\n894\u2013\n6.\nDOI: 10.1592\/phco.19.10.894.31561"},{"key":"i2168-9709-14-1-23-b05","series-title":"J Clin Psychopharmacol","first-page":"440","article-title":"Serotonin syndrome as a result of fluoxetine in a patient with tramadol abuse: plasma level-correlated symptomatology","volume":"22","author":"Lange-Asschenfeldt","year":"2002","unstructured":"Lange-Asschenfeldt\n              C\n            ,\nWeigmannH,\nHiemkeC,\nMannK.\n          Serotonin syndrome as a result of fluoxetine in a patient with tramadol abuse: plasma level-correlated symptomatology.\nJ Clin Psychopharmacol2002;\n22:\n440\u2013\n1.\nDOI: 10.1097\/00004714-200208000-00022"},{"key":"i2168-9709-14-1-23-b06","series-title":"Psychosomatics","first-page":"258","article-title":"Possible serotonin syndrome in association with 5-HT(3) antagonist agents","volume":"42","author":"Turkel","year":"2001","unstructured":"Turkel\n              SB\n            ,\nNadalaJG,\nWincorMZ.\n          Possible serotonin syndrome in association with 5-HT(3) antagonist agents.\nPsychosomatics2001;\n42:\n258\u2013\n60.\nDOI: 10.1176\/appi.psy.42.3.258"},{"issue":"(4)","key":"i2168-9709-14-1-23-b07","series-title":"Ochsner J","first-page":"533","article-title":"Serotonin syndrome","volume":"13","author":"Volpi-Abadie","year":"2013","unstructured":"Volpi-Abadie\n              J\n            ,\nKayeAM,\nKayeAD.\n          Serotonin syndrome.\nOchsner J.\n2013Winter;\n13(4):\n533\u2013\n40. PMID: 24358002"},{"key":"i2168-9709-14-1-23-b08","series-title":"Psychiatr Danub","first-page":"1227","article-title":"Distinguishing between neuroleptic malignant syndrome and serotonin syndrome in polypharmacy: an overview with a case report","volume":"33","author":"Debeljak","year":"2021","unstructured":"Debeljak\n              T\n            ,\nKores Plesni\u010darB.\n          Distinguishing between neuroleptic malignant syndrome and serotonin syndrome in polypharmacy: an overview with a case report.\nPsychiatr Danub.\n2021Spring;\n33(Suppl 4):\n1227\u2013\n9. PMID: 35354191"},{"issue":"(4)","key":"i2168-9709-14-1-23-b09","series-title":"J Emerg Medicine","first-page":"615","article-title":"Treatment of the serotonin syndrome with cyproheptadine","volume":"16","author":"Graudins","year":"1998","unstructured":"Graudins\n              A\n            ,\nStearmanA,\nChanB.\n          Treatment of the serotonin syndrome with cyproheptadine.\nJ Emerg Medicine.\n1998;\n16(4):\n615\u2013\n9.\nDOI: 10.1016\/S0736-4679(98)00057-2"},{"issue":"(7-8)","key":"i2168-9709-14-1-23-b10","series-title":"Ann Pharmacother. 9th ed","first-page":"870","article-title":"Serotonin syndrome: early management with cyproheptadine","volume":"35","author":"McDaniel","year":"2001","unstructured":"McDaniel\n              WW.\n            \n          \n          Serotonin syndrome: early management with cyproheptadine.\nAnn Pharmacother. 9th ed.\n2001;\n35(7-8):\n870\u2013\n3.\nDOI: 10.1345\/aph.10203"},{"issue":"(1)","key":"i2168-9709-14-1-23-b11","series-title":"Br J Anaesth","first-page":"129","article-title":"Neuroleptic malignant syndrome","volume":"85","author":"Adnet","year":"2000","unstructured":"Adnet\n              P\n            ,\nLestavelP,\nKrivosic-HorberR.\n          Neuroleptic malignant syndrome.\nBr J Anaesth.\n2000;\n85(1):\n129\u2013\n35.\nDOI: 10.1093\/bja\/85.1.129"},{"issue":"(9)","key":"i2168-9709-14-1-23-b12","series-title":"PS","first-page":"1163","article-title":"Neuroleptic malignant syndrome: a review","volume":"49","author":"Pelonero","year":"1998","unstructured":"Pelonero\n              AL\n            ,\nLevensonJL,\nPandurangiAK.\n          Neuroleptic malignant syndrome: a review.\nPS.\n1998;\n49(9):\n1163\u2013\n72.\nDOI: 10.1176\/ps.49.9.1163"},{"issue":"(9)","key":"i2168-9709-14-1-23-b13","series-title":"J Clin Psychiatry","first-page":"1222","article-title":"An international consensus study of neuroleptic malignant syndrome diagnostic criteria using the Delphi method","volume":"72","author":"Gurrera","year":"2011","unstructured":"Gurrera\n              RJ\n            ,\nCaroffSN,\nCohenA,\nCarrollBT,\nDeRoosF,\nFrancisA,\net al.\n          An international consensus study of neuroleptic malignant syndrome diagnostic criteria using the Delphi method.\nJ Clin Psychiatry.\n2011;\n72(9):\n1222\u2013\n8.\nDOI: 10.4088\/JCP.10m06438"},{"key":"i2168-9709-14-1-23-b14","series-title":"TCRM","first-page":"757","article-title":"Safety, tolerability, and risks associated with first- and second-generation antipsychotics: a state-of-the-art clinical review","volume":"13","author":"Solmi","year":"2017","unstructured":"Solmi\n              M\n            ,\nMurruA,\nPacchiarottiI,\nUndurragaJ,\nVeroneseN,\nFornaroM,\net al.\n          Safety, tolerability, and risks associated with first- and second-generation antipsychotics: a state-of-the-art clinical review.\nTCRM.\n2017;\n13:\n757\u2013\n77.\nDOI: 10.2147\/TCRM.S117321"},{"issue":"(1)","key":"i2168-9709-14-1-23-b15","series-title":"J Emerg Medicine","first-page":"66","article-title":"Psychiatric emergencies for clinicians: emergency department management of neuroleptic malignant syndrome","volume":"51","author":"Wilson","year":"2016","unstructured":"Wilson\n              MP\n            ,\nVilkeGM,\nHaydenSR,\nNordstromK.\n          Psychiatric emergencies for clinicians: emergency department management of neuroleptic malignant syndrome.\nJ Emerg Medicine.\n2016;\n51(1):\n66\u2013\n9.\nDOI: 10.1016\/j.jemermed.2015.10.042"},{"issue":"(16)","key":"i2168-9709-14-1-23-b16","series-title":"Am J Health Syst Pharm","first-page":"1344","article-title":"Commonly prescribed medications and potential false-positive urine drug screens","volume":"67","author":"Brahm","year":"2010","unstructured":"Brahm\n              NC\n            ,\nYeagerLL,\nFoxMD,\nFarmerKC,\nPalmerTA.\n          Commonly prescribed medications and potential false-positive urine drug screens.\nAm J Health Syst Pharm.\n2010;\n67(16):\n1344\u2013\n50.\nDOI: 10.2146\/ajhp090477"},{"issue":"(3)","key":"i2168-9709-14-1-23-b17","series-title":"Mo Med","first-page":"206","article-title":"Buyer beware: pitfalls in toxicology laboratory testing","volume":"112","author":"Algren","year":"2015","unstructured":"Algren\n              DA\n            ,\nChristianMR.\n          Buyer beware: pitfalls in toxicology laboratory testing.\nMo Med.\n2015;\n112(3):\n206\u2013\n10. PMID: 26168592"},{"issue":"(11)","key":"i2168-9709-14-1-23-b18","series-title":"Clin Chimica Acta","first-page":"1","article-title":"Vortioxetine use may cause false positive immunoassay results for urine methadone","volume":"499","author":"Uljon","year":"2019","unstructured":"Uljon\n              S\n            ,\nKatariaY,\nFloodJG.\n          Vortioxetine use may cause false positive immunoassay results for urine methadone.\nClin Chimica Acta.\n2019;\n499(11):\n1\u2013\n3.\nDOI: 10.1016\/j.cca.2019.08.026"},{"issue":"(9)","key":"i2168-9709-14-1-23-b19","series-title":"QJM","first-page":"635","article-title":"The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity","volume":"96","author":"Dunkley","year":"2003","unstructured":"Dunkley\n              EJC\n            ,\nIsbisterGK,\nSibbrittD,\nDawsonAH,\nWhyteIM.\n          The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity.\nQJM.\n2003;\n96(9):\n635\u2013\n42. PMID: 12925718"},{"issue":"(2)","key":"i2168-9709-14-1-23-b20","series-title":"Clin Pharmacol Ther","first-page":"239","article-title":"A method for estimating the probability of adverse drug reactions","volume":"30","author":"Naranjo","year":"1981","unstructured":"Naranjo\n              CA\n            ,\nBustoU,\nSellersEM,\nSandorP,\nRuizI,\nRobertsEA,\net al.\n          A method for estimating the probability of adverse drug reactions.\nClin Pharmacol Ther.\n1981;\n30(2):\n239\u2013\n45. PMID: 7249508"},{"issue":"(10)","key":"i2168-9709-14-1-23-b21","series-title":"CNS Spectr","first-page":"536","article-title":"Mechanism of action of trazodone: a multifunctional drug","volume":"14","author":"Stahl","year":"2009","unstructured":"Stahl\n              SM.\n            \n          \n          Mechanism of action of trazodone: a multifunctional drug.\nCNS Spectr.\n2009;\n14(10):\n536\u2013\n46.\nDOI: 10.1017\/s1092852900024020"},{"issue":"(1)","key":"i2168-9709-14-1-23-b22","series-title":"P T","first-page":"36","article-title":"Vortioxetine (Brintellix): a new serotonergic antidepressant","volume":"40","author":"D\u2019Agostino","year":"2015","unstructured":"D\u2019Agostino\n              A\n            ,\nEnglishCD,\nReyJA.\n          Vortioxetine (Brintellix): a new serotonergic antidepressant.\nP T.\n2015;\n40(1):\n36\u2013\n40. PMID: 25628505"},{"issue":"(1)","key":"i2168-9709-14-1-23-b23","series-title":"Drugs R D. 5th ed","first-page":"45","article-title":"Second-generation antipsychotics and neuroleptic malignant syndrome: systematic review and case report analysis","volume":"15","author":"Belvederi Murri","year":"2015","unstructured":"Belvederi Murri\n              M\n            ,\nGuaglianoneA,\nBuglianiM,\nCalcagnoP,\nRespinoM,\nSerafiniG,\net al.\n          Second-generation antipsychotics and neuroleptic malignant syndrome: systematic review and case report analysis.\nDrugs R D. 5th ed.\n2015;\n15(1):\n45\u2013\n62.\nDOI: 10.1007\/s40268-014-0078-0"},{"issue":"(4)","key":"i2168-9709-14-1-23-b24","series-title":"Indian J Ment Health","first-page":"390","article-title":"Atypical presentation of neuroleptic malignant syndrome associated with lurasidone: a case report","volume":"7","author":"Arikera","year":"2020","unstructured":"Arikera\n              S\n            ,\nVangalK,\nNaikN.\n          Atypical presentation of neuroleptic malignant syndrome associated with lurasidone: a case report.\nIndian J Ment Health.\n2020;\n7(4):\n390.\nDOI: 10.30877\/IJMH.7.4.2020.390-393"},{"issue":"(5)","key":"i2168-9709-14-1-23-b25","series-title":"PM&R","first-page":"383","article-title":"Neuroleptic malignant syndrome associated with the use of carbidopa\/levodopa for dystonia in persons with cerebral palsy","volume":"4","author":"Perry","year":"2012","unstructured":"Perry\n              D\n            ,\nBirthiP,\nSallesS,\nMcDowellS.\n          Neuroleptic malignant syndrome associated with the use of carbidopa\/levodopa for dystonia in persons with cerebral palsy.\nPM&R.\n2012;\n4(5):\n383\u2013\n4.\nDOI: 10.1016\/j.pmrj.2011.11.008"},{"issue":"(1)","key":"i2168-9709-14-1-23-b26","series-title":"Bmc Psychiatry","article-title":"Lamotrigine, quetiapine and aripiprazole-induced neuroleptic malignant syndrome in a patient with renal failure caused by lithium: a case report","volume":"20","author":"Szota","year":"2020","unstructured":"Szota\n              AM\n            ,\nRadajewskaI,\nGrudzkaP,\nAraszkiewiczA.\n          Lamotrigine, quetiapine and aripiprazole-induced neuroleptic malignant syndrome in a patient with renal failure caused by lithium: a case report.\nBmc Psychiatry.\n2020;\n20(1).\nDOI: 10.1186\/s12888-020-02597-x"}],"container-title":["Mental Health Clinician"],"original-title":[],"link":[{"URL":"https:\/\/mhc.kglmeridian.com\/view\/journals\/mhcl\/14\/1\/article-p23.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/meridian.allenpress.com\/mhc\/article-pdf\/14\/1\/23\/3326059\/i2168-9709-14-1-23.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/mhc.kglmeridian.com\/downloadpdf\/journals\/mhcl\/14\/1\/article-p23.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/mhc.kglmeridian.com\/downloadpdf\/journals\/mhcl\/14\/1\/article-p23.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,20]],"date-time":"2024-11-20T00:33:03Z","timestamp":1732062783000},"score":1,"resource":{"primary":{"URL":"https:\/\/mhc.kglmeridian.com\/view\/journals\/mhcl\/14\/1\/article-p23.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2]]},"references-count":26,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.9740\/mhc.2024.02.023","relation":{},"ISSN":["2168-9709"],"issn-type":[{"value":"2168-9709","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2]]}}}