The neuroleptic malignant syndrome: An Indian experience

A study was performed to investigate the clinical presentation and outcome of the neuroleptic malignant syndrome (NMS) in a large teaching psychiatric hospital in India. Thirteen cases were identified after a thorough search of intensive care unit (ICU) records during the 4-year period between 1990 and 1993. Information collected from these cases was then compared against date from a representative control group of 252 inpatients who received neu roleptics, drawn randomly from each of the 4 years of the study. Statistica l comparisons were made using Student's t test, the chi-square test, and Fi sher's exact test. The incidence of NMS was 1.41 per 1,000 cases treated wi th neuroleptics (95% confidence interval, 0.71 to 2.14 per 1,000) and the m ortality from NMS was 39%. Patients who developed NMS had a significantly h igher incidence of coexisting physical or neurological illness and received a higher mean neuroleptic dose. Neuroleptic loading rates were not differe nt in the NMS and control samples. Fluphenazine decanoate was implicated as a causative factor of NMS in a significantly higher proportion of these pa tients. The group with a fatal outcome was significantly older and received a higher neuroleptic dose than the control group, but not compared with th e group that recovered. Copyright (C) 1999 by W.B. Saunders Company.