Roy Perlis
A. Central features
1. Delirium
2. Rigidity (lead pipe)
3. Fever
4. Autonomic instability (tachycardia, diaphoresis, labile
BP)
B. Laboratory values (though primarily a clinical
diagnosis!)
1. Elevated CPK (MM fraction)
2. Elevated WBC (not always)
C. Risk factors
1. Most often seen with typical neuroleptics.
2. Nonetheless, also reported with atypicals including
clozapine.
3. Lithium may increase risk.
D. Differential diagnosis
1. Catatonia (should not be febrile)
2. Delirium (diaphoretic in NMS, dry skin in
anticholinergic delirium)
3. Severe parkinsonism (should not have delta MS unless
infxn)
E. Treatment
1. Discontinue neuroleptic
2. Pharmacologic options
· dantrolene or bromocriptine
· benzodiazepines
3. Supportive management
· hydration
· antipyretics
· monitor vitals, cardiac rhythm
· follow for rhabdomyolysis, renal failure, arrhythmias,
hypoTN
source: Hyman SE and Tesar GE (1994) Manual of Psychiatric
Emergencies. Little, Brown.