Neuroleptic Malignant Syndrome
Aetiology
Risk factors
Clinical Features
F ever
A utonomic changes (e.g. increased HR/ BP, sweating)
R igidity of muscles
M ental status changes (e.g. confusion)
Note: FARM symptoms are also seen in Serotonin Syndrome (SS). NMS has pallor but SS has flushing and GI symptoms (vomiting + diarrhoea)
Investigations
Bloods:
Treatment
Prognosis
Mortality: 5%
Source
Toronto Notes 2012
- Due to massive dopamine blockade; increased incidence with high potency and depot neuroleptics (aka antipsychotics)
Risk factors
- Medication factors
- Sudden increase in dosage, or starting a new drug
- Patient factors
- Medical illness
- Dehydration
- Exhaustion
- Poor nutrition
- External heat load
- Male
- Young adults
Clinical Features
F ever
A utonomic changes (e.g. increased HR/ BP, sweating)
R igidity of muscles
M ental status changes (e.g. confusion)
Note: FARM symptoms are also seen in Serotonin Syndrome (SS). NMS has pallor but SS has flushing and GI symptoms (vomiting + diarrhoea)
Investigations
Bloods:
- FBC (leukocytosis), CPK (↑), myoglobin (↑)
Treatment
- Discontinue drug
- Hydration
- Dantrolene (hydrantoin derivative, used as a muscle relaxant),
- Bromocriptine (DA agonist)
Prognosis
Mortality: 5%
Source
Toronto Notes 2012