Neuroleptic Malignant Syndrome

Question 1

Define neuroleptic malignant syndrome.

Answer 1

Neuroleptic malignant syndrome is a life-threatening complication of treatment with dopamine antagonists, or occasionally abrupt withdrawal of dopamine agonists.

Question 2

What are risk factors for neuroleptic malignant syndrome?

Answer 2

All antipsychotic medications have been associated with NMS, presumably through their antagonism of dopamine D2 receptors.

Question 3

Summarise the epidemiology of neuroleptic malignant syndrome.

Answer 3

Uncommon

Question 4

Recognise the presenting signs and symptoms of neuroleptic malignant syndrome.

Answer 4

• Hyperthermia
• Muscle rigidity
• Altered mental status
• Sympathetic nervous system lability
• Hypermetabolism

Question 5

Identify appropriate investigations for neuroleptic malignant syndrome and interpret the results.

Answer 5

• Serum creatine kinase (CK)
• Blood gas
• Blood glucose
• Urea, electrolytes, and creatinine
• FBC
• Liver function tests
• Clotting screen
• ECG
• Myoglobin levels and urinalysis

Question 6

What is the management for neuroleptic malignant syndrome?

Answer 6

Stop dopamine antagonist
Supportive therapy

Consider benzodiazepines or dopamine agonists (e.g. dantrolene) or ECT.

Question 7

What are complications associated with neuroleptic malignant syndrome?

Answer 7

• Sepsis
• AKI
• Status epilepticus
• Rhabdomyolysis
• Pulmonary embolism
• Aspiration pneumonia
• Cognitive deficits
• Permanent neurological disability
• Worsening of psychosis