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Neuroleptic malignant syndrome

S N Caroff1, S C Mann

  • 1Department of Psychiatry, University of Pennsylvania, Philadelphia.

The Medical Clinics of North America
|January 1, 1993
PubMed
Summary
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Neuroleptic malignant syndrome (NMS) is a rare, severe reaction to neuroleptic drugs. Early recognition and treatment, including drug withdrawal and supportive care, improve outcomes and reduce mortality.

Area of Science:

  • Neuroscience
  • Psychiatry
  • Pharmacology

Background:

  • Neuroleptic malignant syndrome (NMS) is a rare but life-threatening adverse drug reaction.
  • It affects approximately 0.2% of patients treated with neuroleptic medications.
  • Risk factors include prior NMS episodes, dehydration, agitation, and neuroleptic administration details.

Purpose of the Study:

  • To review the diagnostic criteria, risk factors, and management strategies for neuroleptic malignant syndrome.
  • To discuss the pathophysiology, particularly the role of dopamine.
  • To highlight treatment options and recurrence risks.

Main Methods:

  • Review of existing literature and clinical observations on NMS.
  • Analysis of diagnostic criteria, including hyperthermia, muscle rigidity, mental status changes, and autonomic dysfunction.

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  • Evaluation of treatment modalities such as drug discontinuation, supportive care, dopamine agonists, dantrolene, and electroconvulsive therapy.

    • Main Results:

    • Standardized diagnostic criteria for NMS have been established.
    • Treatment involves early recognition, drug withdrawal, supportive care, and potentially dopamine agonists or dantrolene.
    • Mortality has decreased due to improved management, but recurrence is possible.

    Conclusions:

    • Neuroleptic malignant syndrome requires prompt recognition and management.
    • Dopamine agonist therapy and supportive care are crucial.
    • Further research into NMS pathophysiology may lead to safer neuroleptic drugs and risk reduction strategies.