Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- altered mental status
- muscle rigidity
- autonomic dysfunction
- hyperthermia
- psychiatric hx
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
Treatment algorithm
Contributors
Authors
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
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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