小结
Определение
History and exam
Key diagnostic factors
- presença de fatores de risco
- estado mental alterado
- rigidez muscular
- disfunção autonômica
- hipertermia
- história psiquiátrica
Other diagnostic factors
- história de deficiência de ferro
- história de doença de Wilson
Risk factors
- exposição a medicamentos antipsicóticos
- anormalidade estrutural do cérebro
- supressão abrupta de medicamentos dopaminérgicos
- idade avançada
- agitação preexistente
- acatisia
- sexo masculino
- deficiência de ferro
- catatonia
- desidratação preexistente
- exposição a antagonistas dopaminérgicos e outros antipsicóticos
Diagnostic tests
1st tests to order
- Hemograma completo
- creatina quinase sérica
- perfil metabólico básico
- tomografia computadorizada (TC) cranioencefálica
- ressonância nuclear magnética (RNM) cranioencefálica
- níveis de mioglobina e urinálise
- urocultura
- hemocultura
- punção lombar
- análise toxicológica
- radiografia torácica
Tests to consider
- ferro sérico
- eletroencefalograma
Treatment algorithm
episódio inicial
recidiva
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.
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.
References
Key articles
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed, text revision (DSM-5-TR). Washington, DC: American Psychiatric Association; 2022.
Reference articles
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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