[Neuroleptic malignant syndrome in a patient treated with olanzapine]

Neuroleptic malignant syndrome is a potentially fatal reaction to antipsychotic drugs, characterised by hyperthermia, rigidity, autonomic instability and muscle injury. The syndrome was originally associated with traditional neuroleptics, but may also occur during treatment with second-generation atypical antipsychotic drugs.

We present a case of neuroleptic malignant syndrome in a 52-year-old patient who had been treated for 2(1/2) years with olanzapine, a new atypical antipsychotic agent. He had previously been treated with a conventional neuroleptic for 25 years.

For 2-3 days the patient's condition was serious and unstable, requiring care in the emergency unit. When he was discharged after 12 days' hospitalisation, he was still physically disabled and needed care in his home.

Neuroleptic malignant syndrome may develop even after long and stable treatment with atypical antipsychotic agents. The condition should be suspected in psychiatric patients who present with unclear hyperthermia and muscular rigidity. Essential therapeutic principles are cooling, rehydration, correction of electrolytic disturbances, cardiac monitoring, regular tests of renal function and creatine kinase. Treatment of malign hyperthermia with dantrolene should also be considered.