Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- altered mental status
- muscle rigidity
- autonomic dysfunction
- hyperthermia
- psychiatric history
Other diagnostic factors
- history of iron deficiency
- history 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 dopamine antagonists and other antipsychotics
Diagnostic investigations
1st investigations to order
- FBC
- 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
Treatment algorithm
Contributors
Authors
Ronald J. Gurrera, MD
Associate Professor
Harvard Medical School
Boston
MA
Disclosures
RJG is a member of the Neuroleptic Malignant Syndrome Professional Advisory Board, and has given expert testimony in medical malpractice tort claims in which NMS was alleged. He is an author of several references cited in this topic.
Acknowledgements
Dr Ronald J. Gurrera would like to gratefully acknowledge Dr Peter F. Buckley, a previous contributor to this topic. 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.
Peer reviewers
Alison Haddow, MBBS
Consultant Psychiatrist
Honorary Senior Clinical Lecturer
Royal Cornhill Hospital
Aberdeen
UK
Disclosures
AH declares that she has no competing interests.
John Lauriello, MD
Professor and Chair
Department of Psychiatry
University of Missouri-Columbia
Columbia
MO
Disclosures
JL declares that he has no competing interests.
Ganesh Gopalakrishna, MD
Assistant Professor
Department of Psychiatry
University of Missouri-Columbia
Columbia
MO
Disclosures
GG declares that he has no competing interests.
Use of this content is subject to our disclaimer