Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • altered mental status
  • muscle rigidity
  • autonomic dysfunction
  • hyperthermia
  • psychiatric hx

Other diagnostic factors

  • hx of iron deficiency
  • hx of Wilson's disease

Risk factors

  • exposure to antipsychotic medications
  • abrupt withdrawal of dopaminergic drugs
  • structural brain abnormality
  • older age
  • pre-existing agitation
  • akathisia
  • male sex
  • iron deficiency
  • catatonia
  • pre-existing dehydration
  • exposure to other dopamine antagonists

Diagnostic investigations

1st investigations to order

  • FBC
  • serum CK
  • basic metabolic panel
  • brain CT scan
  • brain MRI
  • myoglobin levels and urinalysis
  • urine culture
  • blood culture
  • lumbar puncture
  • toxicology screen
  • chest x-ray
Full details

Treatment algorithm

ACUTE
ONGOING

Contributors

Authors VIEW ALL

Associate Professor

Harvard Medical School

Boston

MA

Disclosures

RJG is occasionally retained as an expert witness in tort claims where NMS is alleged to have occurred. He is an author of several references cited in this monograph.

Dr Ronald J. Gurrera would like to gratefully acknowledge Dr Peter F. Buckley, a previous contributor to this monograph. PFB is on the advisory board (a voluntary, uncompensated role) of the Neuroleptic Malignant Syndrome Information Service. He is also a consultant to Janssen Pharmaceutica and the National Institute of Mental Health (NIMH). He is conducting or has recently conducted research with funding support from AstraZeneca, NIMH, Janssen Pharmaceutica, Pfizer, Solvay, and Wyeth. Previous consultancy and research support has been from Abbott, Alamo Pharmaceuticals, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Lundbeck, Janssen Pharmaceutica, Merck, NIMH, Roche Diagnostics, Pfizer, Solvay, and Wyeth. PFB has no patents or stock in any company. He is an author of several references cited in this monograph. PFB is a co-investigator on a study also involving Dr John Lauriello and Dr Daniel R. Wilson, who were reviewers for this monograph.

Peer reviewers VIEW ALL

Consultant Psychiatrist

Honorary Senior Clinical Lecturer

Royal Cornhill Hospital

Aberdeen

UK

Disclosures

AH declares that she has no competing interests.

Professor and Chair

Department of Psychiatry

University of Missouri-Columbia

Columbia

MO

Disclosures

JL declares that he has no competing interests.

Assistant Professor

Department of Psychiatry

University of Missouri-Columbia

Columbia

MO

Disclosures

GG declares that he has no competing interests.

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