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Областная клиническая психиатрическая больница №1, Тверь
а) высокие дозы нейролептиков, особенно стартовые [15, 21, 34, 40, 50, 87, 129, 148, 163, 173, 175]; б) быстрое повышение нейролептической нагрузки (дозы антипсихотика) [3, 15, 19–21, 29, 34, 37, 62, 63, 68–70, 86, 87, 90, 129, 148, 173, 175, 177, 181, 185]; в) изначальное использование высокопотентного препарата или переход на него [21, 29, 38, 87, 163, 164, 173, 175]; г) применение препаратов пролонгированного действия [21, 40, 50, 87, 129, 173, 175]; д) парентеральное (внутримышечное) введение лекарственных препаратов [1, 15, 19, 20, 29, 34, 63, 68–70, 86, 87, 129, 148, 163, 173, 177, 185]; е) совместное использование предрасполагающих лекарственных веществ, таких, например, как литий, антихолинергические средства, некоторые антидепрессанты [1, 19, 20, 29, 42, 50, 68–70, 86, 87, 129, 132, 173, 177]; ж) отмена антипаркинсонических препаратов [19, 21, 50, 60, 70, 94, 112, 123, 129, 151, 161, 165, 186]; з) электросудорожная терапия (ЭСТ) в анамнезе [173]; и) недостаточный контроль над нейролептическими экстрапирамидными знаками [129]; к) высокая температура и влажность окружающей среды [19–22, 35, 50, 62, 69, 72, 79, 80, 87, 129, 130, 154, 166, 181, 188].
а) дегидратация организма – важнейшее условие возникновения ЗНС, что подчеркивают все авторы [1–3, 19, 20, 29, 37, 38, 50, 62, 63, 68, 69, 70, 72, 79, 80, 86, 87, 90, 91, 129, 141, 145, 163, 173, 177, 181, 185, 188]; б) физическое истощение, в том числе алиментарное, также отмечают большинство исследователей [1, 20–22, 29, 35, 63, 68–70, 86, 87, 129, 130, 163, 177, 185, 188]; в) алкоголизм [20, 29, 62, 68, 69, 86, 87, 129, 177, 181]; г) дефицит железа [99, 129, 140, 164]; д) органические заболевания головного мозга с мозговой недостаточностью [1, 19, 20–22, 29, 35, 36, 62, 63, 68–70, 86, 87, 129, 130, 163, 177, 181, 185], такие как умственная отсталость [63, 70], черепно-мозговая травма и посттравматическая энцефалопатия [20–22, 29, 35, 68, 69, 86, 87, 130, 177], стойкие экстрапирамидные нарушения [38, 62, 69, 129, 181], деменция (в том числе в исходе ВИЧ-инфекции) [20–22, 29, 35, 68, 69, 86, 87, 130, 177], причем особое место отводится деменции с тельцами Леви, страдающие которой чрезвычайно чувствительны к нейролептикам [117]; е) эпизоды ЗНС в анамнезе [19, 28, 29, 50, 70, 125, 129, 150, 163, 173]; ж) кататония в анамнезе [19, 33, 48, 50, 126, 129, 136, 137, 163, 173, 189]; з) психомоторное возбуждение [1, 15, 19, 29, 34, 50, 63, 70, 76, 87, 92, 129, 141, 145, 148, 155, 163, 173, 185]; и) послеродовой период [9, 117, 173].
1) рабдомиолиз; 2) острая почечная недостаточность (ОПН); 3) острая дыхательная недостаточность: легочная эмболия, аспирационная пневмония, отек легких, респираторный дистресс-синдром взрослых (шоковое легкое); 4) сердечная патология: аритмии, острый инфаркт миокарда, внезапная остановка сердца; 5) эпилептиформные припадки; 6) ДВС-синдром; 7) инфекционные осложнения: колибациллярный фасциит, сепсис, мочевые инфекции; 8) печеночная недостаточность; 9) ухудшение психического состояния после отмены нейролептиков; 10) церебральная нейрональная дегенерация.
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