Letter to the Editor
Abstract
Introduction In response to the Letter to the Editor by Dr. Andrew Francis and Dr. Adeeb Yacoub regarding the article “Catatonic variants, hyperthermic extrapyramidal reactions, and subtypes of neuroleptic malignant syndrome,” Annals of Clinical Psychiatry 2007;19:9-16. AUTHOR'S REPLY As Dr. Francis and Dr. Yacoub point out, the finding that 5 of the 14 NMS episodes in the naturalistic study did not meet criteria for catatonia or respond to benzodiazepines is at variance with some studies, which show a close relationship between catatonia and NMS ( 1 , 2 ). Consistent with these studies, however, the remaining 9 episodes all had concurrent catatonia and most of them showed positive responses to benzodiazepines. The absence of catatonia in some NMS episodes and their lack of responses to benzodiazepines—an effective treatment for acute catatonia—cast doubt over the hypothesis that all NMS episodes are severe variants of catatonia and NMS and catatonia are one single entity. Dr. Francis and Dr. Yacoub rightly query if the NMS episodes were stringently assessed for catatonia and the poor responses to benzodiazepines were due to sub-optimal dosage of benzodiazepines. The diagnosis of catatonia, masked or overshadowed by NMS features, could be easily missed, and some NMS