Neuroleptic malignant syndrome
Neuroleptic malignant syndrome is "potentially fatal syndrome associated primarily with the use of neuroleptic agents (see antipsychotic agents) which are in turn associated with dopaminergic receptor blockade in the basal ganglia and hypothalamus, and sympathetic dysregulation. Clinical features include diffuse muscle rigidity; tremor; high fever; diaphoresis; labile blood pressure; cognitive dysfunction; and autonomic disturbances. Serum CPK level elevation and a leukocytosis may also be present."
Neuroleptic malignant syndrome usually shows fever, "lead-pipe" rigidity of muscles, mental status changes, and autonomic instability.
The distinction between serotonin syndrome, neuroleptic malignant syndrome, malignant hyperthermia, and toxicity from cholinergic agents has been reviewed (see chart). The most difficult distinction is between serotonin syndrome and neuroleptic malignant syndrome as patients may be on drugs that could cause either disorder. Serotonin syndrome shows hyperkinesia, hyperreflexia, and hyperactive bowel sounds, while neuroleptic malignant syndrome shows bradykinesia, bradyreflexia and normal or diminished bowel sounds. A helpful guide is that "dopamine antagonists [such as used to sedate a psychosis] produce bradykinesia, whereas serotonin agonists [such as used to activate a depression] produce hyperkinesia". Lastly, neuroleptic malignant syndrome may develop over several days while serotonin syndrome develops faster.
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