Neuroleptic malignant syndrome

概述 
理论 
诊断 
治疗 
随访 
资源 

最后审阅： 19 Aug 2025

最后更新： 20 Mar 2025

Neuroleptic malignant syndrome (NMS) is a potentially life-threatening complication of treatment with antipsychotic drugs, or abrupt withdrawal of dopamine agonists.

Characterized by a tetrad of altered mental status, muscle rigidity, autonomic instability, and hyperthermia.

A diagnosis of exclusion. Common differential diagnoses are sepsis and drug reactions.

NMS is a medical emergency. Treatment consists of immediate cessation of the offending medication (or resumption of the dopamine agonist) and provision of supportive measures (hydration and cooling). Additional treatment may be considered if supportive interventions fail.

A delay of at least 2 weeks in restarting antipsychotic treatment is advised following full resolution of an NMS episode.

Documenting this reaction in the medical records is important.

定义

NMS is an uncommon, idiosyncratic, life-threatening complication of treatment with antipsychotic medications. NMS has also been associated with use of other psychotropic agents that block central dopamine pathways (e.g., metoclopramide) and with abrupt cessation of dopamine agonists. It is characterized by altered mental state, increased muscle tone or frank rigidity, dysregulated autonomic nervous system, hyperactivity, and hyperthermia.[1][2][3][4] None of these signs are exclusive to this condition, and other important diagnoses (e.g., sepsis) should be excluded first.[5][6]

This topic covers the diagnosis and management of neuroleptic malignant syndrome in adults.

病史和体格检查

关键诊断因素

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

完整详情

危险因素

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

完整详情

诊断性检查

首要检查

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

完整详情

需考虑的检查

serum iron
electroencephalogram

完整详情

治疗流程

急症处理

initial episode

持续性治疗

recurrence

撰稿人

专家顾问

Ronald J. Gurrera, MD

Associate Professor

Harvard Medical School

Boston

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

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

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

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

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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.

鉴别诊断
- Sepsis
- Status epilepticus
- Drug misuse/overdose
更多鉴别诊断
პაციენტის ბროშურები
Neuroleptic malignant syndrome
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Neuroleptic malignant syndrome

小结

定义

病史和体格检查

关键诊断因素

危险因素

诊断性检查

首要检查

需考虑的检查

治疗流程

initial episode

recurrence

撰稿人

专家顾问

Ronald J. Gurrera, MD

利益声明

鸣谢

利益声明

同行评议者

Alison Haddow, MBBS

利益声明

John Lauriello, MD

利益声明

Ganesh Gopalakrishna, MD

利益声明

Peer reviewer acknowledgements

Disclosures

参考文献

关键文献

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.

鉴别诊断

პაციენტის ბროშურები

შედით სისტემაში ან გამოიწერეთ BMJ Best Practice

შედით სისტემაში ან გამოიწერეთ BMJ Best Practice

შედით სისტემაში BMJ Best Practice-ის მასალებზე სრული წვდომისთვის