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Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal complication of antipsychotic drug use. This review provides a comprehensive overview of NMS, including its epidemiology, clinical presentation, pathogenesis, and management. The article emphasizes the importance of early recognition and intensive care management in improving outcomes for patients with this serious condition.
Key Points:
- NMS is characterized by fever, muscular rigidity, and dysautonomia following exposure to dopamine-blocking agents, particularly antipsychotic drugs.
- The syndrome occurs in an estimated 0.02% to 3% of patients exposed to implicated drugs, with mortality rates ranging from 4.7% at 30 days to 15.1% at 1 year.
- Clinical features include dysautonomia, hyperthermia, delirium or catatonia, and increased muscle tone, often leading to rhabdomyolysis and potential renal failure.
- Treatment involves a tiered approach, including withdrawal of the offending agent, supportive care, and specific interventions such as dantrolene, bromocriptine, or electroconvulsive therapy in severe cases.
- Management in the intensive care unit focuses on addressing blood pressure instability, hyperthermia, rhabdomyolysis, and potential respiratory compromise.
- Although the risk of recurrence exists, cautious reintroduction of antipsychotic medication may be necessary for underlying psychiatric conditions, with a preference for low-potency or atypical agents.
- Further research is needed to understand genomic variants, recurrence risk, and optimal intensive care management strategies for NMS.
HCN Medical Memo
Physicians should maintain a high index of suspicion for neuroleptic malignant syndrome in patients on antipsychotic medications presenting with fever, rigidity, and autonomic dysfunction. Early recognition and prompt, intensive management are crucial for improving outcomes in this potentially life-threatening condition.
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