Which of the following statements regarding neuroleptic malignant syndrome (NMS) is correct?

A. Neuroleptic malignant syndrome is a rare complication of neuroleptic treatment.
B. The condition is characterized by a hypometabolic state.
C. This syndrome is only associated with phenothiazine neuroleptic treatment.
D. Neuroleptic malignant syndrome has not yet been reported in non-psychotic patients receiving neuroleptics.
E. Neuroleptic malignant syndrome is more likely to occur during the chronic phase of psychiatric illness in persons stabilized on a medication regimen.
 

• Answer A is correct.

• Neuroleptic malignant syndrome is a rare, but frequently fatal, complication of neuroleptic treatment.

• The syndrome is related to acute decreases in dopaminergic activity in the central nervous system (e.g., use of dopamine antagonists).

• Neuroleptic malignant syndrome is characterized by a hypermetabolic state with hyperthermia, muscle rigidity, and autonomic dysfunction.

• This syndrome has been associated with phenothiazine as well as non-phenothiazine neuroleptics and has been more commonly associated with high potency agents administered in therapeutic dosages.

• The syndrome has also been seen with sudden cessation or decrease in dosage of dopamine agonists in patients with idiopathic Parkinson’s disease.

• Non-neuroleptic agents such as metoclopramide and hydroxyzine may also be associated with NMS.

• Neuroleptic malignant syndrome has also been reported in non-psychotic patients receiving neuroleptics.

• Neuroleptic malignant syndrome is more likely to occur during an acute phase of psychiatric illness, while the patient is being treated with multiple neuroleptics concurrently.  Additionally, the syndrome may occur after changes in medication, from one neuroleptic to another, or after dosage increases.

References:  3, 4, and 5

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