Neuroleptic malignant syndrome
Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- history of exposure to antipsychotic medications
- history of abrupt withdrawal of dopaminergic drugs
- altered mental status
- muscle rigidity
- autonomic dysfunction
- hyperthermia
Factores de riesgo
- exposure to antipsychotic medications
- structural brain abnormality
- abrupt withdrawal of dopaminergic drugs
- older age
- preexisting agitation
- akathisia
- male sex
- iron deficiency
- catatonia
- preexisting dehydration
- exposure to other dopamine antagonists
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- CBC
- serum creatine kinase
- basic metabolic panel
- brain CT scan
- brain MRI
- myoglobin levels and urinalysis
- urine culture
- blood culture
- lumbar puncture
- toxicology screen
- chest x-ray
Pruebas diagnósticas que deben considerarse
- serum iron
- electroencephalogram
Algoritmo de tratamiento
initial episode
recurrence
Colaboradores
Consejeros especializados
Ronald J. Gurrera, MD
Associate Professor
Harvard Medical School
Boston, MA
Divulgaciones
RJG declares that he has no competing interests.
Agradecimientos
Dr Ronald J. Gurrera would like to gratefully acknowledge Dr Peter F. Buckley, a previous contributor to this topic.
Divulgaciones
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 topic. PFB is a co-investigator on a study also involving Dr John Lauriello and Dr Daniel R. Wilson, who were reviewers for this topic.
Revisores por pares
Alison Haddow, MBBS
Consultant Psychiatrist
Honorary Senior Clinical Lecturer
Royal Cornhill Hospital
Aberdeen
UK
Divulgaciones
AH declares that she has no competing interests.
John Lauriello, MD
Professor and Chair
Department of Psychiatry
University of Missouri-Columbia
Columbia, MO
Divulgaciones
JL declares that he has no competing interests.
Ganesh Gopalakrishna, MD
Assistant Professor
Department of Psychiatry
University of Missouri-Columbia
Columbia, MO
Divulgaciones
GG declares that he has no competing interests.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
References
Key articles
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed, text revision (DSM-5-TR). Washington, DC: American Psychiatric Association; 2022.
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Sepsis
- Status epilepticus
- Drug misuse/overdose
More DifferentialsPatient information
Neuroleptic malignant syndrome
More Patient information
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