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Psychiatry Psychopharmacology Emergency Advanced
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Neuroleptic Malignant Syndrome Features

F
E
V
E
R
Life-threatening idiosyncratic reaction to dopamine D2-receptor antagonist antipsychotics.

Sudden central dopamine D2 blockade in the striatum and hypothalamus disrupts thermoregulation and causes intense skeletal muscle contraction.

Systematic Breakdown

F

Fever (Hyperthermia)

Extreme core temperature elevation often exceeding 38°C - 40°C (104°F).

E

Encephalopathy

Altered mental status, delirium, stupor, or catatonia.

V

Vitals Unstable (Autonomic Instability)

Labile blood pressure, tachycardia, tachypnea, and profuse diaphoresis.

E

Elevated Enzymes (CK)

Marked serum creatine kinase (CK) elevation and myoglobinuria due to rhabdomyolysis.

R

Rigidity ('Lead-Pipe')

Severe generalized 'lead-pipe' muscle rigidity distinguishes NMS from serotonin syndrome (which has hyperreflexia/clonus).

High-Yield Clinical Pearls & Exam Tips
  • NMS vs Serotonin Syndrome: NMS is characterized by 'Lead-Pipe' rigidity and hyporeflexia; Serotonin syndrome features hyperreflexia, tremor, and neuromuscular clonus.
  • First step in management: Immediately discontinue the offending neuroleptic, initiate aggressive cooling and hydration, and consider Dantrolene or Bromocriptine.
Related Pharmaceuticals
Haloperidol Fluphenazine Dantrolene Bromocriptine
Related Clinical Conditions
Rhabdomyolysis Serotonin Syndrome Malignant Hyperthermia
Authoritative Sources: Kaplan & Sadock's Synopsis of Psychiatry 12e · UpToDate: Neuroleptic malignant syndrome

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