Neurolept Malignant Syndrome

Dr Swapnil Pawar March 11, 2022 336

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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