CLINICAL AND PHARMACOLOGICAL RISK-FACTORS FOR NEUROLEPTIC MALIGNANT SYNDROME - A CASE-CONTROL STUDY

Background: Pharmacologic and clinical risk factors for neuroleptic ma lignant syndrome have been suggested. High neuroleptic dose, vapid dos age increase, and parenteral administration were identified as risk fa ctors in a case-control study; however, there are limited data regardi ng potential clinical risk factors. Methods: To examine potential clin ical risk factors, rye conducted a case-control study, comparing 12 ca ses to 24 controls, all treated with neuroleptics at our center. In ad dition To examining previously postulated pharmacologic risk factors, we also assessed for presence of psychomotor agitation, confusion, dis organization, and catatonia. Results: Significant differences were fou nd between cases and controls for psychomotor agitation, confusion, di sorganization, catatonia, mean and maximum neuroleptic dose, parentera l neuroleptic injections, neuroleptic nose increase within 5 days of t he episode, magnitude of neuroleptic dose increase from initial dose, and extrapy-ramidal signs. Conclusions: This study demonstrated that p sychopathological features such as psychomotor agitation, confusion, d isorganized behavior and catatonia may be risk factors for the neurole ptic malignant syndrome, in addition to pharmacologic risk factors and extrapyramidal signs, including akathisia. In clinical practice, care ful monitoring for prodromal signs of neuroleptic malignant syndrome i s required during neuroleptic treatment of patients with psychomotor a gitation, confusion, and/or disorganization, while in the presence of catatonia these drugs should be avoided. Biol Psychiatry 1998;44: 748- 754 (C) 1998 Society of Biological Psychiatry.