This Dirty Dozen is about catatonia, neuroleptic malignant syndrome (NMS), and serotonin syndrome. Their clinical features overlap in many ways, and I try to clarify how to distinguish them. I’m indebted to the resources in the reference list below, especially the The Neuroleptic Malignant Information Service. Up until about a year ago the NMS Information Service (NMSIS) had an 800 number which you could use to call for assistance from internationally recognized experts. That is no longer available, unfortunately. However, there’s a gold mine of educational guidance on the web site and I often use it to stay informed about these syndromes. The service is free and they take donations.
In order to see the picture galleries of photos or powerpoint slides, click on one of the slides, which will open up the presentation to fill the screen. Use the arrow buttons to scroll left and right through the slides or up and down to view the annotations.
References and Web Resources:
Perry, P. J. and C. A. Wilborn (2012). “Serotonin syndrome vs neuroleptic malignant syndrome: A contrast of causes, diagnoses, and management.” Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists 24(2): 155-162.
BACKGROUND: Serotonin syndrome (SS) and neuroleptic malignant syndrome (NMS) are uncommon but potentially life-threatening adverse reactions associated with psychotropic medications. Polypharmacy and the similar presentation of SS and NMS make diagnosis of the 2 syndromes problematic. METHODS: A MEDLINE search was performed for the period 1960 to 2011 for case reports, review articles, and studies pertaining to SS and NMS. RESULTS: The majority of available literature on SS and NMS consists of case reports, case-control studies, and retrospective reviews. In addition, diagnostic criteria have been developed to aid in the diagnosis and management of SS and NMS. CONCLUSIONS: SS presents as mental status changes, autonomic nervous system disturbances, neurologic manifestations, and hyperthermia. Similarly, NMS presents as muscle rigidity, hyperpyrexia, mental status changes, and autonomic instability. However, the clinical laboratory profile of elevations in creatine kinase, liver function tests (lactate dehydrogenase, aspartate transaminase), and white blood cell count, coupled with a low serum iron level, distinguishes NMS from SS among patients taking neuroleptic and serotonin agonist medications simultaneously. For both SS and NMS, immediate discontinuation of the causative agent is the primary treatment, along with supportive care. For NMS, dantrolene is the most effective evidence-based drug treatment whereas there are no evidence-based drug treatments for SS. A 2-week washout of neuroleptic medication minimizes the chance of recurrence.
Support Services: Neuroleptic Malignant Syndrome Information Service, The Neuroleptic Malignant Information Service where internationally recognized experts provide free educational guidance on diagnosis and management of NMS.