Neuroleptic malignant syndrome: recognizing an unrecognized killer.

NMS has been with us for years as an often unrecognized entity. Nurses ask why there are "more of these cases" when what might be happening is that NMS is being discovered for what it is. There have been cases where the authors are convinced that the "pneumonia" or "urinary tract infection" was in fact a mild case of NMS that cleared. Probably some of the "sudden deaths" that have been reported in the past with neuroleptics are the results of undiagnosed NMS. Any patient with a fever, fluctuating vital signs, and signs of difficulty with moving should be considered as a possible case of NMS. All nurses and physicians need to be aware of the possibility, but those who work with psychiatric patients must not forget this potentially life-threatening problem.

Concomitant treatment of neuroleptic malignant syndrome and psychosis.

Two cases are presented in which psychotic patients with neuroleptic malignant syndrome were treated with bromocriptine and thioridazine simultaneously, with a resulting control of both problems. The authors feel that this method needs further study, in the light of the potentially large number of patients at risk for these illnesses. The use of creatinine phosphokinase level as an indicator of value in NMS is also discussed.

Neuroleptic malignant syndrome.

Neuroleptic malignant syndrome is an uncommon, occasionally lethal reaction to drug therapy. Patients taking neuroleptic medication are usually the victims of this complex disorder, but others, such as patients with Parkinson's disease, are also at risk. The classic presentation includes autonomic instability, rigidity, hyperthermia, confusion and other neurologic symptoms. Family physicians may be the first to see these patients and must be able to make the diagnosis quickly to avoid delay in treatment.