Neuroleptic malignant syndrome: advances in diagnosis and treatment

Neuroleptic malignant syndrome (NMS) was identified during early trials of haloperidol over sixty years ago. However, NMS remained obscure until hundreds of clinical reports increased recognition and confirmed acceptance of NMS as a severe drug reaction associated with dopamine-2-receptor blocking agents used primarily as antipsychotics. The prolonged delay in acceptance of NMS as an iatrogenic condition occurred in part because it was often misdiagnosed leading to tragic and fatal consequences from continued or aggressive antipsychotic treatment. In subsequent years, the accumulation of published observations enabled a more precise consensus definition of NMS, clarified risk factors and treatment strategies, renewed interest in catatonia and related hyperthermic disorders, and shed light on the pathophysiology of the syndrome. Increased awareness facilitating early diagnosis, more conservative use of antipsychotic medications, and the introduction of newer antipsychotics with fewer adverse neurological effects have reduced the incidence and mortality of NMS. In this webinar, Dr. Stanley N. Caroff will discuss evaluation, differential diagnosis, and treatment of NMS in medical as well as psychiatric settings, which remain unfamiliar to most practicing physicians. This is alarming given that antipsychotics are increasingly promoted and prescribed to an expanding number of patients, and that NMS remains potentially lethal if unrecognized, underscoring the need for continued study of this serious drug reaction.