Summary
The clinical triad of fever, movement disorder, and altered mentation known as NMS represents an infrequent yet highly lethal side effect of neuroleptic therapy. Although awareness and recognition are on the rise, underdiagnosis of the disorder may represent a neglected clinical problem of major proportions considering the number of patients treated with neuroleptics.
The recognition of problems such as NMS and tardive dyskinesia point out the need for investigation of low-dose efficacy and neuroleptic serum levels. The idea that neuroleptics are free of severe side effects has created a clinical fallacy that high doses of high potency neuroleptics should be administered to acutely psychotic patients and that low doses of neuroleptics may be used for various diagnostic entities. The emphasis on NMS and its 20% mortality rate should point out that neuroleptics should only be used when clinically indicated to treat psychosis and should be given in the lowest possible dose that achieves antipsychotic effects.
Although treatment strategies are still being formulated, aggressive medical care and specific drug therapies exist to reverse the symptoms of this syndrome. With proper education, psychiatrists and other specialists can recognize and treat NMS effectively and thus prevent its malignant outcome.
Similar content being viewed by others
References
Abbott RJ, Loizou LA. Neuroleptic malignant syndrome. British Journal of Psychiatry 148: 47–51, 1986
Birkhimer LJ, De Vane CL. The neuroleptic malignant syndrome: presentation and treatment. Drug Intelligence and Clinical Pharmacy 18: 462–465, 1984
Blue MG, Schneider SM, Noro S, Fraley DS. Successful treatment of neuroleptic malignant syndrome with sodium nitroprusside. Annals of Internal Medicine 104: 56–57, 1986
Caroff SN. The neuroleptic malignant syndrome. Journal of Clinical Psychiatry 41: 79–83, 1980
Caroff SN, Rosenberg H, Gerber JC. Neuroleptic malignant syndrome and malignant hyperthermia. Lancet 1: 244, 1983
Clark T, Ananthy J, Dubin S. On the early recognition of neuroleptic malignant syndrome. International Journal of Psychiatry in Medicine 15: 299–310, 1985-1986
Coons DJ, Hillman FJ, Marshall RW. Treatment of neuroleptic malignant syndrome with dantrolene sodium: a case report. American Journal of Psychiatry 139: 944–945, 1982
Cooper JR, Bloom FE, Roth RH. The biochemical basis of neuropharmacology, 5th ed., Oxford Press, 1986
Cope RV, Gregg EM. Neuroleptic malignant syndrome. British Medical Journal 286: 1938, 1983
Cummins P. Neuroleptic malignant syndrome. British Journal of Psychiatry 144: 556, 1983
Editorial. Dantrolene for malignant hyperthermia during anesthesia. Medical Letter 22: 61–63, 1980
Gibb WRG, Griffith DNW. Levodopa withdrawal syndrome identical to neuroleptic malignant syndrome. Postgraduate Medical Journal 62: 59–60, 1986
Gibb WRG, Lees AJ. The neuroleptic malignant syndrome: a review. Quarterly Journal of Medicine 220: 421–429, 1985
Granato JE, Stern BJ, Ringel A, Karmi AH, Krumholz A, et al. Neuroleptic malignant syndrome: successful treatment with dantrolene and bromocriptine. Annals of Neurology 14: 89–90, 1983
Hashimoto F, Sherman CB, Jeffrey WH. Neuroleptic malignant syndrome and dopamine blockade. Archives of Internal Medicine 144: 629–630, 1984
Jessee SS, Anderson FG. ECT in the neuroleptic malignant syndrome: case report. Journal of Clinical Psychiatry 44: 186–188, 1983
Kurlan R, Hamill R, Shoulson I. Neuroleptic malignant syndrome. Clinical Neuropharmacology 7: 109–120, 1984
Lazurus A. Therapy of neuroleptic malignant syndrome. Psychiatric Developments 1: 19–30, 1986
Levinson DF, Simpson GM. Neuroleptic-induced extrapyramidal symptoms in fever. Archives of General Psychiatry 43: 839–848, 1986
Lew TY, Tollefson G. Chlorpromazine-induced neuroleptic malignant syndrome and its response to diazepam. Biological Psychiatry 18: 1441–1447, 1983
Mann SC, Caroff SN, Bleier HR, Werner KRW, King MA, et al. Lethal catatonia. American Journal of Psychiatry 143: 1374–1379, 1986
McCarron MM, Boettger ML, Peck JJ. A case of neuroleptic malignant syndrome successfully treated with amantadine. Journal of Clinical Psychiatry 43: 381–382, 1982
Pelonero AL, Levenson JL, Silvermann JJ. Neuroleptic therapy following neuroleptic malignant syndrome. Psychosomatics 26: 946–948, 1985
Pope HG, Cole JO, Choras PT, Fulwiler CE. Apparent neuroleptic malignant syndrome with clozapine and lithium. Journal of Nervous and Mental Disease 174: 493–495, 1986
Pope HG, Keck PE, McElroy SL. Frequency and presentation of neuroleptic malignant syndrome in a large psychiatric hospital. American Journal of Psychiatry 143: 1227–1232, 1986
Rodgers J, Stoudemire A. Neuroleptic malignant syndrome in multiple sclerosis masked by baclofen. Psychosomatics, in press, 1987
Sangal R, Dimitrievic R. Neuroleptic malignant syndrome: successful treatment with pancuronium. Journal of the American Medical Association 254: 2795–2796, 1985
Schaffer CF. Neuroleptic malignant syndrome. Western Journal of Medicine 138: 408–409, 1983
Simpson DM, Davis GC. Case report of neuroleptic malignant syndrome associated with withdrawal from amantadine. American Journal of Psychiatry 141: 796–797, 1984
Sternberg DE. Neuroleptic malignant syndrome: the pendulum swings. American Journal of Psychiatry 143: 1273–1275, 1986
Stoudemire A. The differential diagnosis of catatonic states. Psychosomatics 23: 245–252, 1982
Stoudemire A, Luther JS. Neuroleptic malignant syndrome: differential diagnosis and treatment. International Journal of Psychiatry in Medicine 14: 57–63, 1984
Tollefson G. A case of neuroleptic malignant syndrome. Journal of Clinical Psychopharmacology 2: 266–270, 1982
Tollefson G, Garvey MJ. The neuroleptic syndrome and central dopamine metabolites. Journal of Clinical Psychopharmacology 4: 150–153, 1984
Woo J, Teoh R, Vallance-Owen J. Neuroleptic malignant syndrome successfully treated with amantidine. Correspondence. Postgraduate Medical Journal 62: 809–810, 1986
Zubenko G, Pope HB. Management of a case of neuroleptic malignant syndrome with bromocriptine. American Journal of Psychiatry 140: 1619–1620, 1983
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Harpe, C., Stoudemire, A. Aetiology and Treatment of Neuroleptic Malignant Syndrome. Med Toxicol Adverse Drug Exp 2, 166–176 (1987). https://doi.org/10.1007/BF03259862
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03259862