Neuroleptic malignant syndrome: a retrospective analysis - abstract

ABSTRACT

Antipsychotic (neuroleptic) drugs control symptoms of psychosis by blocking the central dopaminergic receptors. This reaction alleviates symptoms but can lead to neuroleptic malignant syndrome (NMS), a life-threatening adverse drug reaction to neuroleptics. The records of all patients diagnosed as suffering from NMS during the period January, 1989 to October, 1992 were analyzed. A total of 5,562 patients (4,168 males and 1,394 females) were treated as inpatients with neuroleptics at the Psychiatric Hospital in Barbados during the same period. A total of 11 cases (0.195 per cent) were diagnosed as suffering from NMS and had to be transferred to the Queen Elizabeth Hospital for further management. All patients were of African descent and we are unaware of any large scale study on the incidence of NMS in patients of African descent. The incidence of females (0.65 per cent) was much higher than in males (0.05 per cent). The mortality rate in these patients was very high (45 per cent) which may be due to the use of high doses of neuroleptics and also the use of combinations of haloperidol and depot (fluphenazine/flupenthixol) preparations, which are considered high-risk drugs for NMS. The mortality rate in patients managed conservatively was 75 per cent whereas in those receiving bromocriptine and/or dantrolene it was 29 per cent. General medical practitioners should be aware of NMS because early diagnosis and prompt initiation of treatment with drugs like bromocriptine and/or dantrolene would reduce the mortality considerably (AU)