NEUROLEPTIC MALIGNANT SYNDROME - RECOGNITION, PREVENTION AND MANAGEMENT

Neuroleptic malignant syndrome (NMS) is a rare but potentially lethal form of drug-induced hyperthermia characterised by mental status chang es, muscle rigidity, hyperthermia and autonomic dysfunction. Increased awareness and early recognition will lead to prompt management. The d iagnosis of NMS presents a challenge because several medical condition s generate similar symptoms. The presentation and course of NMS can be quite variable ranging from a stormy and potentially fatal course to a relatively benign and self-limiting course. The most important aspec t of treatment is prevention. This includes reducing risk factors (e.g . dehydration, agitation and exhaustion), early recognition of suspect ed cases and prompt discontinuation of the offending agent. All patien ts with psychosis should be monitored daily for dehydration and elevat ed temperature, have vital signs checked and agitation should be watch ed for. Antipsychotics should be used conservatively with gradual titr ation of doses. The management of NMS should be based on a hierarchy o f symptom severity. Following an episode of NMS, the patient should be reassessed for further treatment with antipsychotics and rechallenge should not be attempted at least 2 weeks following resolution of sympt oms of NMS. The patient and family should be educated about the episod e and consent for further medication use obtained after a clear explan ation of the risk-benefit analysis.