Neuroleptic Malignant Syndrome

Neuroleptic malignant syndrome (NMS) is a rare and potentially fatal reaction that may occur during treatment with antipsychotic agents (Croarkin et al. 2008; Strawn et al. 2007). NMS has been estimated to occur in 0.2%-1% of patients treated with dopa-mine-blocking agents. NMS has been reported in other neurological disorders (e.g., Wilson's disease, Parkinson's disease) treated with dopamine-block-ing agents. NMS may also occur in patients treated with dopamine antagonists given for nausea (e.g., metoclopramide, prochlorperazine). Malnutrition and dehydration in the context of an organic brain syndrome and simultaneous treatment with lithium and antipsychotic agents may increase the risk. Mortality rates may be as high as 20%-30% due to dehydration, aspiration, renal failure, and respiratory collapse. Differential diagnosis of NMS in cludes heatstroke, malignant hyperthermia, lethal catatonia, serotonin syndrome, and anticholinergic toxicity (Haddad and Dursun 2008) (see Table 306). There may be a 30% risk of recurrent NMS if antipsychotic agents are restarted.

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