Neuroleptic Malignant Syndrome, with Attention to Its Occurrence with Atypical Antipsychotic Medication

The neuroleptic malignant syndrome (NMS) is an idiopathic, life-threatening reaction to antipsychotic medication. NMS was traditionally attributed to potent dopamine antagonism of typical antipsychotics, but cases of NMS have now been reported for each of the newer antipsychotics. When NMS is caused by a newer, atypical antipsychotic the presentation differs somewhat; fever, rigidity, and, possibly, death may be less frequent. Diagnostic features, predisposing factors, and treatment are discussed, as is the important matter of reinstituting antipsychotic treatment. Neuroleptic malignant syndrome (NMS) is an idiosyncratic, life-threatening reaction to antipsychotic medication, characterized principally by delirium, fever, autonomic instability, and muscular rigidity (1). Most cases occur within a month of starting the medication, two-thirds within the first week. NMS develops in 0.02-2.44 percent of patients who are prescribed antipsychotics (2-4); NMS may occur even when doses are in the therapeutic range; the risk is somewhat greater with rapid dose escalation and with parenteral administration