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Journal of the National Medical Association logoLink to Journal of the National Medical Association
. 1992 Nov;84(11):966–970.

Neuroleptic malignant syndrome.

M S Jahan 1, A I Farooque 1, Z Wahid 1
PMCID: PMC2571745  PMID: 1460685

Abstract

Neuroleptic malignant syndrome is a life-threatening reaction of neuroleptic medication. The estimated incidence rate of neuroleptic malignant syndrome is between 1% and 1.5% of patients treated with neuroleptics. The reported mortality rate varies from 11% to 38%. Risk factors include younger males (80% less than 40 years) and physical disability. Although 80% of neuroleptic malignant syndrome cases develop within the first 2 weeks of treatment, the syndrome can develop anytime during the therapy period. The clinical picture and laboratory findings are not always unique. Less than 50% of cases manifest with classical symptoms. Deaths usually result from cardiovascular collapse. Renal failure, pulmonary emboli, aspiration pneumonia, and respiratory failure are also reported. Familiarity with the syndrome, baseline laboratory values including creatine phosphokinase, lactate dehydrogenase, serum glutamicoxaloacetic transaminase, and complete blood cell count with a differential count, and a high index of suspicion are of the utmost importance in making the diagnosis of neuroleptic malignant syndrome. A judicial choice of neuroleptic medication and careful observation of patients may reduce the incidence, morbidity, and mortality of neuroleptic malignant syndrome.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Addonizio G., Susman V. L. ECT as a treatment alternative for patients with symptoms of neuroleptic malignant syndrome. J Clin Psychiatry. 1987 Mar;48(3):102–105. [PubMed] [Google Scholar]
  2. Caroff S. N. The neuroleptic malignant syndrome. J Clin Psychiatry. 1980 Mar;41(3):79–83. [PubMed] [Google Scholar]
  3. Coons D. J., Hillman F. J., Marshall R. W. Treatment of neuroleptic malignant syndrome with dantrolene sodium: a case report. Am J Psychiatry. 1982 Jul;139(7):944–945. doi: 10.1176/ajp.139.7.944. [DOI] [PubMed] [Google Scholar]
  4. Goekoop J. G., Carbaat P. A. Treatment of neuroleptic malignant syndrome with dantrolene. Lancet. 1982 Jul 3;2(8288):49–50. doi: 10.1016/s0140-6736(82)91189-8. [DOI] [PubMed] [Google Scholar]
  5. Granato J. E., Stern B. J., Ringel A., Karim A. H., Krumholz A., Coyle J., Adler S. Neuroleptic malignant syndrome: successful treatment with dantrolene and bromocriptine. Ann Neurol. 1983 Jul;14(1):89–90. doi: 10.1002/ana.410140117. [DOI] [PubMed] [Google Scholar]
  6. Guzé B. H., Baxter L. R., Jr Current concepts. Neuroleptic malignant syndrome. N Engl J Med. 1985 Jul 18;313(3):163–166. doi: 10.1056/NEJM198507183130306. [DOI] [PubMed] [Google Scholar]
  7. Henderson V. W., Wooten G. F. Neuroleptic malignant syndrome: a pathogenetic role for dopamine receptor blockade? Neurology. 1981 Feb;31(2):132–137. doi: 10.1212/wnl.31.2.132. [DOI] [PubMed] [Google Scholar]
  8. Hooper J. F., Herren C. K., Goldwasser H. Neuroleptic malignant syndrome: recognizing an unrecognized killer. J Psychosoc Nurs Ment Health Serv. 1989 Jul;27(7):13–15. doi: 10.3928/0279-3695-19890701-09. [DOI] [PubMed] [Google Scholar]
  9. Itoh H., Ohtsuka N., Ogita K., Yagi G., Miura S., Koga Y. Malignant neuroleptic syndrome--its present status in Japan and clinical problems. Folia Psychiatr Neurol Jpn. 1977;31(4):559–576. [PubMed] [Google Scholar]
  10. Jessee S. S., Anderson G. F. ECT in the neuroleptic malignant syndrome: case report. J Clin Psychiatry. 1983 May;44(5):186–188. [PubMed] [Google Scholar]
  11. Kurlan R., Hamill R., Shoulson I. Neuroleptic malignant syndrome. Clin Neuropharmacol. 1984;7(2):109–120. doi: 10.1097/00002826-198406000-00001. [DOI] [PubMed] [Google Scholar]
  12. Lew T. Y., Tollefson G. Chlorpromazine-induced neuroleptic malignant syndrome and its response to diazepam. Biol Psychiatry. 1983 Dec;18(12):1441–1446. [PubMed] [Google Scholar]
  13. Lindvall O., Björklund A., Skagerberg G. Dopamine-containing neurons in the spinal cord: anatomy and some functional aspects. Ann Neurol. 1983 Sep;14(3):255–260. doi: 10.1002/ana.410140302. [DOI] [PubMed] [Google Scholar]
  14. May D. C., Morris S. W., Stewart R. M., Fenton B. J., Gaffney F. A. Neuroleptic malignant syndrome: response to dantrolene sodium. Ann Intern Med. 1983 Feb;98(2):183–184. doi: 10.7326/0003-4819-98-2-183. [DOI] [PubMed] [Google Scholar]
  15. Pearlman C. A. Neuroleptic malignant syndrome: a review of the literature. J Clin Psychopharmacol. 1986 Oct;6(5):257–273. [PubMed] [Google Scholar]
  16. Pope H. G., Jr, Cole J. O., Choras P. T., Fulwiler C. E. Apparent neuroleptic malignant syndrome with clozapine and lithium. J Nerv Ment Dis. 1986 Aug;174(8):493–495. doi: 10.1097/00005053-198608000-00010. [DOI] [PubMed] [Google Scholar]
  17. Rosebush P. I., Stewart T. D., Gelenberg A. J. Twenty neuroleptic rechallenges after neuroleptic malignant syndrome in 15 patients. J Clin Psychiatry. 1989 Aug;50(8):295–298. [PubMed] [Google Scholar]

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