Neuroleptic malignant syndrome

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Última revisión: 14 Aug 2025
Última actualización: 20 Mar 2025

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
Todos los datos

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
Todos los datos

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
Todos los datos

Pruebas diagnósticas que deben considerarse

  • serum iron
  • electroencephalogram
Todos los datos

Algoritmo de tratamiento

Agudo

initial episode

En curso

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.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed, text revision (DSM-5-TR). Washington, DC: American Psychiatric Association; 2022.

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

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