Neurolept Malignant Syndrome

Dr Swapnil Pawar March 11, 2022 307

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    Neurolept Malignant Syndrome
    Dr Swapnil Pawar

Neuroleptic Malignant Syndrome

Clinical Features of NMS

Altered mental state: Agitated delirium with confusion, and can sometimes present as catatonia and mutism. Progresses to stupor and coma

Muscular Rigidity: Often presents as lead pipe rigidity, but may appear cogwheeling if there is superimposed tremor

Hyperthermia: Often >38 degrees celsius, but may also reach >40

Autonomic Instability: Usually presents with tachycardia, tachypnoea and hypertension +/- labile blood pressure

Serotonin Syndrome vs. NMS

Serotonin Syndrome NMS
Reflexes Hyper-reflexic Hypo-reflexic
Bowel Sounds Increased Normal
Pupils Dilated Normal
Onset Hours Days to weeks
Duration Rapid Prolonged


Side Effects of Anti-Psychotics

Anti-Dopaminergic: Extra-Pyramidal Side Effects (Akathisia, Acute Dystonia, Parkinsonism, Tardive Dyskinesia)

Anti-Serotonergic: Weight gain, hyperlipidaemia, hyperglycaemia

Anti-Histamine: Sedation

Anticholinergic: Urinary retention, dry mouth, constipation, tachycardia, blurred vision

Anti-Adrenergic: Postural hypotension

Typical vs. Atypical Anti-Psychotics


Typical (1st Gen)  Atypical (2nd Gen) 
Examples Haloperidol, Chlorpromazine, Fluphenazine Risperidone, Olanzapine, Clozapine, Quetiapine
Action D2 antagonism 5HT-2A antagonism, weaker D2 antagonism
Efficacy in Schizophrenia Effective on positive symptoms Effective on positive symptoms, some benefit on negative symptoms
Side Effects More likely to cause extra-pyramidal side effects More likely to cause metabolic syndrome


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