Summary
Definition
History and exam
Key diagnostic factors
- history of exposure to antipsychotic medications
- history of abrupt withdrawal of dopaminergic drugs
- history of structural brain abnormality
- altered mental status
- muscle rigidity
- autonomic dysfunction
- hyperthermia
- psychiatric history
Other diagnostic factors
- history of iron deficiency
- history of Wilson disease
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 dopamine antagonists and other antipsychotics
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
Tests to consider
- serum iron
- electroencephalogram
Treatment algorithm
initial episode
recurrence
Contributors
Authors
Ronald J. Gurrera, MD
Associate Professor
Harvard Medical School
Boston
MA
Disclosures
RJG declares that he has no competing interests.
Acknowledgements
Dr Ronald J. Gurrera would like to gratefully acknowledge Dr Peter F. Buckley, a previous contributor to this topic.
Disclosures
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.
Differentials
- Sepsis
- Status epilepticus
- Drug misuse/overdose
More DifferentialsPatient information
Neuroleptic malignant syndrome
More Patient information
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