Comparison of neuroleptic malignant syndrome induced by first- and second-generation antipsychotics

Abstract

Neuroleptic malignant syndrome (NMS) is a rare, idiosyncratic reaction that has been reported in association with both firstand second-generation antipsychotic drugs. Although both the incidence of NMS 1 and NMS-related mortality 2 appear to be declining, the accurate and timely recognition of NMS remains a priority because of its potential severity and its association with long-term neuropsychiatric and physical sequelae.3,4 As classically described, NMS presents with abrupt onset of fever, autonomic instability, extrapyramidal signs (EPS) and altered mental state.

Safety and Tolerability of Antipsychotics

“…NMS is a rare and idiosyncratic reaction reported with both FGAs and SGAs reported to occur between 0.02 % and 0.25 % of patients (Trollor et al 2012 ;Zarrouf and Bhanot 2007 ;Guanci et al 2012 ). Diagnosis of NMS consists of hyperthermia (>100.4 °F or 38 °C on at least two occasions), muscle rigidity, and two of following symptoms: diaphoresis, dysphagia, incontinence, altered consciousness, hypertension (≥25 % above baseline), mutism, labile blood pressure (≥20 mmHg diastolic; ≥ 25 mmHg systolic), creatine kinase (CK) increase (>4 times the upper normal limit), tachypnea (≥50 % above baseline), and tremor or tachycardia (≥25 % above baseline) (Guanci et al 2012 ).…”

Multiple episodes of NMS: overlap with malignant catatonia

“…Therefore clozapi n e -i n d u c e d N M S m a y b e particularly difficult to detect given that tachycardia, blood p r e s s u r e d i s t u r b a n c e a n d pyrexia are common during clozapine initiation due to the effects of clozapine itself or medical complications. 4 …”

“…4 One condition, or two? Due to the differing symptomatology of the NMS episode and the malignant catatonia episode, this case could demonstrate that the two conditions are separate entities.…”

Psychiatric Emergencies for Clinicians: Emergency Department Management of Neuroleptic Malignant Syndrome

“…NMS is more common after high-potency, first-generation antipsychotics (FGAs) like haloperidol, although it can occur with any antipsychotic (Table 1) (4,5). There is some evidence, however, that NMS after SGAs may be less likely to present with rigidity (6).…”