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By Peter M. Haddad, Serdar Dursun, Bill Deakin

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Partial forms of NMS can occur. Pharmacological mechanism Dopamine receptor blockade and central dopamine hypoactivity. Investigations to confirm diagnosis History is important as NMS usually occurs within a few days of commencing the causal agent. Examination will reveal the key signs. Creatine phosphokinase levels usually elevated. qxd 5/5/04 5:33 PM Page 33 NEUROLEPTIC MALIGNANT SYNDROME Management Discontinue all psychotropic medication on suspicion of NMS. e. systemic infections. Benzodiazepines, bromocriptine, dantrolene and possibly electroconvulsive therapy may be helpful in individual patients.

Fricchione G (1985). Neuroleptic catatonia and its relationship to psychogenic catatonia. Br J Psychiatry, 20, 304–13. Fricchione G, Mann SC, and Caroff SN (2000). Catatonia, lethal catatonia, and neuroleptic malignant syndrome. Psychiatric Ann, 30, 347–55. Friedman JH, Feinberg SS, and Feldman RG (1985). A neuroleptic malignant-like syndrome due to levodopa therapy withdrawal. JAMA, 254, 2792–5. Fujitake J, Kuno S, and Nishitani H (1984). Neuroleptic malignant syndrome-like state in eight patients with parkinsomnism.

Key symptoms/signs Changes in consciousness range from mild confusion to coma. Rigidity: can be localized but in later stages usually severe and generalized. Autonomic disturbance: pallor, tachycardia, labile blood pressure, sweating, urinary incontinence Pyrexia: can exceed 42 ЊC in extreme cases. Partial forms of NMS can occur. Pharmacological mechanism Dopamine receptor blockade and central dopamine hypoactivity. Investigations to confirm diagnosis History is important as NMS usually occurs within a few days of commencing the causal agent.

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