Hey, coming at you with another outstanding Clinical Problems in Consultation Psychiatry (CPCP), this one on Neuroleptic Malignant Syndrome (NMS) by Neurology resident Dr. Dan Anderson, DO. NMS is a rare syndrome, occurring in about 1 in 5000 patients and it can progress quickly to a life-threatening condion. Many experts call it a drug-induced malignant catatonia. Because it occurs so rarely, it pays to review it regularly. We see it here every few years. I find it very helpful to contact internationally recognized experts in the field like Dr. Stanley Caroff, MD, who can be reached through the Neuroleptic Malignant Syndrome Information Service (http://www.nmsis.org/). There’s an urgent need to rescue the person who suffers from NMS because it can be fatal quickly.
It’s a diagnosis of exclusion because there are so many medical conditions which can present with delirium, rigidity, and fever. It’s important to remember that NMS is not caused just by antipsychotics but can result from the use of antidopaminergic medications like anti-nausea medications, e.g., compazine. And stopping dopaminergic medications like Sinemet for Parkinson’s Disease abruptly can also cause it.
Most often, simply stopping the offending drugs that cause the syndrome and providing supportive treatment are sufficient interventions. However, the syndrome can progress to dangerous complications such as kidney failure and blood clots and doctors may need to use special drugs like dantrolene, a medicine that can help reduce the damage to muscles called rhabdomyolysis that can result from high fever.
Antipsychotics don’t cause NMS for the great majority of patients who need these drugs for psychotic disorders. While antipsychotics can be restarted after NMS has fully resolved following a two week period, there is a higher risk of recurrence of the syndrome.
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