Neuroleptic Malignant Syndrome (NMS) is an uncommon and potentially life-threatening complication of antipsychotic drug treatment. It is characterized by a triad of symptoms including muscle rigidity, fever, and altered mental status (Mann, Caroff, & Campbell, 2019). NMS is thought to be caused by an overactive dopaminergic system resulting in dopamine receptor hypersensitivity (Kumar & Irving, 2015).
NMS is often underrecognized and can occur in patients of any age, though it tends to be more common in young males (Mann et al., 2019). The majority of cases are associated with the use of high-potency antipsychotics, such as haloperidol and fluphenazine, though it has been reported with all classes of antipsychotic medications (Kumar & Irving, 2015). Common presenting symptoms include muscle rigidity, fever, autonomic instability, altered mental status, and elevated serum creatine phosphokinase levels (Mann et al., 2019).
The diagnosis of NMS is based on clinical presentation and laboratory findings. In particular, an elevated serum creatine phosphokinase is often seen in patients with NMS (Kumar & Irving, 2015). Additionally, electroencephalography (EEG) may be useful in ruling out alternative diagnoses such as encephalopathy or seizures, as these can be seen in patients with NMS (Mann et al., 2019).
The treatment of NMS is primarily supportive and includes the discontinuation of the offending antipsychotic, hydration, and the use of dantrolene or bromocriptine (Kumar & Irving, 2015). Additionally, antipyretics and benzodiazepines may be used to manage fever and autonomic instability (Mann et al., 2019).
In conclusion, Neuroleptic Malignant Syndrome is a rare but potentially life-threatening complication of antipsychotic drug treatment. It is characterized by a triad of symptoms including muscle rigidity, fever, and altered mental status. The diagnosis is based on clinical presentation and laboratory findings, and the treatment is primarily supportive.
References
Kumar, S., & Irving, A. (2015). Neuroleptic malignant syndrome. BMJ Clinical Evidence, 2015(8). doi:10.1136/bmj.h2041
Mann, S. C., Caroff, S. N., & Campbell, E. C. (2019). Neuroleptic malignant syndrome. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK537189/