Neuroleptic malignant syndrome

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources

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Last reviewed: 16 Aug 2025
Last updated: 20 Mar 2025

Summary

Definition

History and exam

Key diagnostic factors

  • history of exposure to antipsychotic medications
  • history of abrupt withdrawal of dopaminergic drugs
  • altered mental status
  • muscle rigidity
  • autonomic dysfunction
  • hyperthermia
Full details

Risk factors

  • 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
Full details

Diagnostic tests

1st tests to order

  • 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
Full details

Tests to consider

  • serum iron
  • electroencephalogram
Full details

Treatment algorithm

ACUTE

initial episode

ONGOING

recurrence

Contributors

Expert advisers

Ronald J. Gurrera, MD

Associate Professor

Harvard Medical School

Boston

MA

利益声明

RJG declares that he has no competing interests.

鸣谢

Dr Ronald J. Gurrera would like to gratefully acknowledge Dr Peter F. Buckley, a previous contributor to this topic.

利益声明

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.

同行评议者

Alison Haddow, MBBS

Consultant Psychiatrist

Honorary Senior Clinical Lecturer

Royal Cornhill Hospital

Aberdeen

UK

利益声明

AH declares that she has no competing interests.

John Lauriello, MD

Professor and Chair

Department of Psychiatry

University of Missouri-Columbia

Columbia

MO

利益声明

JL declares that he has no competing interests.

Ganesh Gopalakrishna, MD

Assistant Professor

Department of Psychiatry

University of Missouri-Columbia

Columbia

MO

利益声明

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.

参考文献

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关键文献

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

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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