Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Key clinical features to recognize Neuroleptic Malignant Syndrome (NMS) in a patient receiving antipsychotic medication include:
- Hyperthermia: A high fever is a hallmark feature, often exceeding 38°C, reflecting the systemic inflammatory response NICE CG178.
- Muscle rigidity: Severe, generalized 'lead-pipe' rigidity is characteristic and differentiates NMS from other conditions NICE NG181.
- Autonomic dysfunction: Manifested by labile or elevated blood pressure, tachycardia, diaphoresis, and tachypnoea NICE CG178.
- Altered mental status: Ranging from agitation and confusion to stupor and coma, indicating central nervous system involvement NICE NG181.
- Elevated creatine kinase (CK): Marked elevation due to muscle breakdown supports the diagnosis, although this is a laboratory rather than clinical feature Mooney & Hasan 1990.
- Other features: May include leukocytosis and metabolic acidosis NICE NG181.
Recognition requires a high index of suspicion in any patient on antipsychotics presenting with this constellation of symptoms, as early diagnosis and management are critical NICE CG178. While atypical antipsychotics may present with a somewhat atypical or less severe syndrome, the core features remain consistent Odagaki 2009.
Key References
- NG181 - Rehabilitation for adults with complex psychosis
- CG178 - Psychosis and schizophrenia in adults: prevention and management
- CG185 - Bipolar disorder: assessment and management
- (Mooney and Hasan, 1990): Neuroleptic malignant syndrome.
- (Levenson, 1985): Neuroleptic malignant syndrome.
- (Odagaki, 2009): Atypical neuroleptic malignant syndrome or serotonin toxicity associated with atypical antipsychotics?