Geriatric Psychopharmacology: A Complex Case of Psychosis Complicated by Neuroleptic Malignant Syndrome (NMS) and Metabolic Syndrome (MetS)

  • Raj Velamoor
  • Gautham Pulagam


Treating psychosis in the elderly can be a significant challenge. The potential for clinical difficulty due to the complex interactions between enzymes, multiple receptor subtypes, and individual variations is highlighted. Here, we present a complex case of psychosis complicated by neuroleptic malignant syndrome and metabolic syndrome. We have outlined the relevant pharmacokinetics, pharmacodynamics, risk factors, and management strategies which can be applied when confronted with multiform cases such as the one presented here.


Pharmacokinetics Pharmacodynamics Polypharmacy Neuroleptic malignant syndrome 



Alanine transaminase


Adenosine monophosphate-activated protein kinase


Aspartate transaminase


Blood urea nitrogen


Creatine phosphokinase


Cardiovascular disease


Cytochrome P 450


Gamma-amniobutyric acid


High-density lipoprotein


Low-density lipoprotein


Liver function test


Metabolic syndrome


Neuroleptic malignant syndrome


Peroxisome proliferator-activated receptor alpha


Selective serotonin reuptake inhibitors


Screening Tool to Alert doctors to Right Treatment


Screening Tool of Older Person’s Prescriptions


Tumor necrosis factor alpha


Disclosure Statement

“The authors have nothing to disclose.”


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Raj Velamoor
    • 1
    • 2
  • Gautham Pulagam
    • 3
  1. 1.Northern Ontario School of MedicineLaurentian and Lakehead UniversitySudburyCanada
  2. 2.Schulich School of MedicineWestern UniversityLondonCanada
  3. 3.Medical University of the Americas, St. Kitts and Nevis University of Toronto at MississaugaMississaugaCanada

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