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Neuroleptic malignant syndrome: a guide for psychiatrists

Article  in  BJPsych Advances · October 2020

DOI: 10.1192/bja.2020.71

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Ovais Wadoo Sami Ouanes

Hamad Medical Corporation Hamad Medical Corporation
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Mudasir Firdosi
Kent and Medway NHS and Social Care Partnership Trust
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Neuroleptic malignant syndrome: a guide for

psychiatrists
BJPsych Advances

OVAIS WADOO, SAMI OUANES, MUDASIR FIRDOSI

DOI: 10.1192/bja.2020.71

Published online: 23 October 2020, pp. 1-10

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SUMMARY
Neuroleptic malignant syndrome (NMS) is a rare and potentially fatal adverse reaction to drugs. In psychiatric
practice, it is mainly associated with antipsychotics. The classic presentation is that of hyperpyrexia, muscle rigidity,
mental state changes and autonomic instability. Subtle forms are difficult to recognise owing to symptom overlap
with other conditions. This article discusses the clinical presentation of the syndrome, its differential diagnosis and
use of supportive care, medication and electroconvulsive therapy in its treatment. It also explores prevention of NMS
and reinstatement of treatment after an episode. It is stressed that all but the mildest forms of NMS should be
considered a medical emergency that is properly managed in an acute hospital.

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