P1: VENDOR/GEE/FYJ/GDP/GOQ P2: GMX
Psychiatric Quarterly [psaq] PHO48-340223 June 12, 2001 9:8 Style ﬁle version Nov. 19th, 1999
Psychiatric Quarterly, Vol. 72, No. 4, 2001
CLINICAL MANAGEMENT OF
NEUROLEPTIC MALIGNANT SYNDROME
Virginia L. Susman, M.D.
Neuroleptic malignant syndrome (NMS) continues to be an unpredictable and
rare, but potentially fatal complication of antipsychotic medications. Presump-
tively linked to dopamine blockade, it nonetheless occurs in patients receiv-
ing newer atypical antipsychotics. The features of NMS, its pathophysiology,
differential diagnosis, clinical course, risk factors, and morbidity and motal-
ity are reviewed. Nonpharmacologic management centers on aggressive sup-
portive care including vigilant nursing, physical therapy, cooling, rehydration,
anticoagulation. Pharmacologic interventions include immediate discontinua-
tion of antipsychotics, judicious use of anticholinergics, and adjunctive benzo-
diazepines. The utility of speciﬁc agents in actively treating NMS is reviewed.
Bromocriptine and other dopaminergic drugs and dantrolene sodium have al-
ternatively been considered without merit or efﬁcacious. Guidelines for using
these agents are presented. Electroconvulsive therapy, also somewhat contro-
versial, is identiﬁed as a second line of treatment. Finally, management of the
post-NMS patient is also reviewed.
KEY WORDS: neuroleptic malignant syndrome; serotonin syndrome; catatonia; hyper-
Virginia L. Susman, M.D., is Associate Medical Director, New York Presbyterian
Hospital, Westchester Division, and Associate Professor of Clinical Psychiatry, Weill
Medical College of Cornell University.
Address correspondence to Virginia L. Susman, M.D., 21 Bloomingdale Road, White
Plains, NY 10605.
2001 Human Sciences Press, Inc.