Re: Neuroleptic Malignant Syndrome Associated with Quetiapine
Bibliographic record
Abstract
Dear Edi tor:We wish to com ment upon the case of neu ro lep tic ma lig nant syn drome (NMS) as so ci ated with queti apine that was reported in the Oc to ber is sue of the Journal (1).The author re ported queti apine use that was fol lowed by 13 days of restless ness, agi ta tion, and dia pho re sis.Loxap ine was then added to the regi men, and the next day the pa tient de vel oped the full ful mi nant syn drome of NMS, meet ing the cri te ria of Leven son (2), Addon izio and oth ers (3), DSM-IV (4), Caroff and oth ers (5), and, proba bly, Pope and oth ers (6).There have been sev eral cases of NMS as so ci ated with the use of atypi cal neu ro lep tics, par ticu larly clozap ine (7).It is strik ing how of ten the pres en ta tion is less ful mi nant with atypical neu ro lep tic use; ex tra py ra mi dal symp toms (EPS), in par ticu lar, are less promi nent.This is not sur pris ing, consid er ing the side-effects pro file of the atypi cals, which show fewer EPS than do clas sic agents.Given the above, we won der whether the author might com ment on the pos si bil ity of loxap ine be ing also a sig nifi cant contrib ut ing cause of the NMS.Loxap ine is a clas sic neu ro lep tic that has been as soci ated with NMS of the more ful mi nant va ri ety (8)-more like the case described by Al-Waneen (1), with prominent EPS and very high cre atine ki nase (CK).We be lieve that, with con comi tant use of loxap ine, it is in cor rect to conclude that queti apine in duced NMS in this case.It is also worth not ing that NMS de vel oped in spite of the use of loraze pam which Fink (9) rec om mends as a treat ment for NMS.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.006 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.009 | 0.003 |
| Insufficient payload (model declined to judge) | 0.012 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".