The true incidence of NMS is not known because the available evidence is inconclusive. Estimates range from 0.02% to 3%. An important limitation when considering published estimates is that they are almost exclusively incidence proportions (number of new cases over a period of time divided by number of persons at risk at the beginning of the time period) rather than true incidence rates (number of new cases over a period of time divided by the person-time at risk). Reported incidence has declined over the last 20 years, which may reflect greater awareness with heightened vigilance and more prompt clinical intervention. Other possible factors may include systematic reporting bias, an evolving practice trend toward the use of second-generation antipsychotic medications (SGAs), and caution in using high initial doses of antipsychotics.
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