Guidance for BrisDoc clinicians assessing patients at the Riverside Unit
Neuroleptic Malignant Syndrome (NMS)
(Taken from Maudsley guidance, 12th Edition 2016)
Neuroleptic Malignant Syndrome is a rare but potentially life-threatening consequence of taking anti-psychotic medication:
“a syndrome essentially of muscular rigidity and sympathetic hyperactivity occurring as a result of dopaminergic antagonism in the context of psychological stressors and genetic predisposition”.
Signs and symptoms:
- Fever, diaphoresis
- Rigidity
- Confusion, fluctuating consciousness
- Fluctuating blood pressure
- Tachycardia
- Elevated creatinine kinase
- Leucocytosis
- Altered liver function tests
Risk factors:
- High potency anti-psychotic drugs
- Recent or rapid dose increase
- Rapid dose reduction
- Abrupt withdrawal of anticholinergics
- Antipsychotic polypharmacy
- Psychosis, organic brain disease, alcoholism, Parkinsonism
- Hyperthyroidism
- Learning disability
- Psychomotor agitation
- Dehydration
If you suspect that a patient has or may have NMS:
- Stop the anti-psychotic medication
- Arrange urgent transfer to the Emergency Department for rehydration, sedation and treatment.