Neuroleptic Malignant Syndrome: A Review and Report of Six Cases
Duangjai Kasantikul MD*, Buranee Kanchanatawan MD*
Affiliation : * Department of Psychiatry, Faculty of Medicine, Chulalongkorn University
The typical symptoms and signs of neuroleptic malignant syndrome (NMS) consist of fever, muscle
rigidity (stiffness, myoclonus, rod-like), alterations of consciousness (confusion, agitation, aggression, or
catatonia), autonomic nervous system disturbances (i.e., hypertension, tachycardia, tachypnea, profuse sweat-
ing, and urine incontinence), abnormal blood tests such as low serum electrolytes, elevated serum creatinine
phosphokinase (CPK) level, and leukocytosis. Muscle rigidity is often associated with myonecrosis, myoglo-
binuria, and elevated serum CPK. The mortality among NMS cases is in the 10 to 70% range depending on the
severity of the symptoms and time of therapeutic approach. Mandatory therapy should include removal of
causative agents, correction of body fluid and electrolytes, administration of benzodiazepine, clonazepam
and bromocriptine (dopamine agonist), proved life-saving medications.
The authors reported herein six cases with unusual clinical features of NMS. Four of them had been
on antipsychotic for a year before becoming anorexic, dehydrated, agitated, and violent with paranoid
delusion. One instance with underlying delirium tremens developed NMS after receiving haloperidol (30mg
IV) in addition to diazepam (200mg IV) within 24 hours. Another patient was found to suffer from severe NMS
after receiving bupropion (Dopamine inhibitor antidepressant) 300 mg. /day. All patients displayed cardinal
signs and symptoms of NMS in addition to dehydration and pallor. They were treated in the psychiatric ward
and recovered rapidly from NMS after receiving clonazepam and bromocriptine and removal of the offending
agents.
Keywords : Catatonia, Neuroleptic malignant syndrome, Serotonin syndrome
