The condition is said to typically develop over a period of 24 to 72 hours and can be precipitated not only by starting neuroleptic
medications but also after abruptly stopping them or changing dose.
Keywords * Neuroleptic
malignant syndrome * Olanzapine * Drug-related side effects
malignant syndrome, Cotard's syndrome, atypical neuroleptic
malignant syndrome, nihilistic delusions, electro-convulsive therapy
Some of the dangerous side effects are hypoglycemia, neuroleptic
malignant syndrome, seizures, and increased risk of death and cerebrovascular events in elderly patients with dementiarelated psychosis (Stahl's Essential Psychopharmacology, prescriber's guide, 5th edition).
An international consensus study of neuroleptic
malignant syndrome diagnostic criteria using the Delphi method.
induced TD is excluded if signs and symptoms are due to other neurologic disorder that may involve basal ganglia or medical disorder like hyperthyroidism or due to ill-fitted dentures or other medications like levodopa, amphetamines, metoclopramide.
At the same time, the neuroleptic
malignant syndrome was coined; it featured numerous similarities with the catatonic syndrome, and a series of recent research studies suggest a potential common origin of the two nosological entities.
The study also showed that inpatient mortality because of neuroleptic
malignant syndrome (NMS) has significantly dropped since it was first described in 1960.
In what concerns to treatment, the pharmacological intervention with atypical neuroleptics
seems to be effective in the remission of the acute episode but its potential to prevent relapse is unclear (2).
Severe withdrawal akathisia following neuroleptic
discontinuation successfully controlled by clozapine.
The diagnostic criteria for neuroleptic
malignant syndrome (NMS) provided in the fourth edition of the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)[21 specify that the individual must exhibit severe muscle rigidity and elevated temperature associated with the use of antipsychotic medication and have at least two of the following associated symptoms: (a) diaphoresis, (b) dysphagia, (c) tremor, (d) incontinence, (e) changes in level of consciousness ranging from confusion to coma, (f) mutism, (g) tachycardia, (h) elevated or labile blood pressure, (i) leukocytosis, or (j) laboratory evidence of muscle injury (e.
In rare cases it can cause neuroleptic
malignant syndrome and symptoms of stiffness, fever and confusion.
malignant syndrome is considered as a rare but potentially fatal complication of neuroleptic
In such a situation, one should use the Neuroleptic
from a different class.
The first choice is an antidepressant or a neuroleptic