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Pathophysiology of neuroleptic malignant syndrome (NMS)
Source publication
Neuroleptic malignant syndrome (NMS) is an infrequent and
life‑threatening adverse effect of antipsychotics, especially the
typical antipsychotics.[1] NMS is characterized by delirium,
muscular rigidity, fever, and autonomic nervous system
dysregulation,[1] as shown in Figure 1. Ameta‑analysis showed
an overall estimate of 0.991 cases per thousand...
Context in source publication
Context 1
... malignant syndrome (NMS) is an infrequent and life-threatening adverse effect of antipsychotics, especially the typical antipsychotics. [1] NMS is characterized by delirium, muscular rigidity, fever, and autonomic nervous system dysregulation, [1] as shown in Figure 1. A meta-analysis showed an overall estimate of 0.991 cases per thousand people. ...
Citations
... 5 According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a diagnosis of NMS (typical) requires all three significant criteria (exposure to a dopamine-blocking agent, severe muscular rigidity, and fever) and at least two of the other criteria (diaphoresis, dysphagia, tremor, incontinence, altered level of consciousness, mutism, tachycardia, elevated or labile blood pressure, leukocytosis, and elevated CPK). 2 NMS is considered atypical when only three of the four cardinal features are present, which include fever, altered mental status (AMS), autonomic dysfunction, or muscle rigidity. 3 NMS is extremely prevalent in individuals with borderline intellectual functioning 6,7 ; however, recent reports have described an atypical presentation of NMS, potentially encompassing symptoms such as ileus, 8,9 acute kidney injury, 10 persistent tachycardia, 11 and others. ...
Background
Neuroleptic malignant syndrome (NMS) is a rare and potentially life‐threatening condition that may arise at any point during treatment and is often associated with adverse reactions to dopamine‐blocking agents. This syndrome is normally characterized by features such as muscle rigidity, alteration in consciousness, autonomic instability, and leukocytosis.
Aim
The aim of this study is to investigate a borderline intellectual functioning (BIF) case in which NMS with insidious disease progression and long prodromal symptoms was developed.
Case Presentation
The investigated patient was a 38‐year‐old female diagnosed with bipolar disorder and a variety of corresponding disorders. The patient exhibited gastrointestinal symptoms and restlessness in the weeks leading up to the study, subsequent to the administration of elevated doses of haloperidol, risperidone, and lithium. In addition, she was hospitalized for restlessness and aggressiveness in the summer of 2023. Furthermore, due to her chief complaint, she received parenteral haloperidol twice in the emergency room, subsequently experiencing fever, altered consciousness, generalized rigidity, and dysphagia. Moreover, the patient's initial creatine phosphokinase (CPK) level was 2550 IU/L, and she was hospitalized in an intensive care unit with the diagnosis of NMS for 8 days.
Conclusions
This case study highlights the necessity of being attentive about prodromal symptoms of NMS and emergent interventions.
