Neuroleptic malignant syndrome. Differential diagnosis

Abstract

Neuroleptic malignant syndrome is one of the most dangerous complications of antipsychotic therapy, rare but very serious, especially with first-generation neuroleptics. It is a medical emergency, an early diagnosis will be necessary and include general supportive measures and symptomatic drug therapy. Objectives NMS is a diagnosis of exclusion that typically occurs between 24–72hours. Rare after two weeks, except that the deposit may extend this period. The course is between 7 and 10 days. Methods We will present a case in which we see the difficulties that arise in daily clinical practice. Results The most characteristic symptoms are engines, such as stiffness (lead pipe), dystonia, tremor, nystagmus, opisthotonos, bradykinesia, dysphagia, dysarthria, lethargy, convulsions, trismus, oculogyric crisis. Changes the state of consciousness (confusion, delirium and stupor or coma). Hyperthermia, above 38.5°C (up to 41). Autonomic instability (hypertension, postural hypotension and variability in blood pressure, tachycardia, tachypnea, salivation, sweating, pale skin, and urinary incontinence). Conclusions It is particularly difficult to make the differential diagnosis with malignant catatonia, by the common features that both products, which are indistinguishable in a quarter of cases, conceptualise the NMS as a form of drug-induced malignant catatonia. This resembles by muscle rigidity, hyperthermia, and akinesia. His appearance is preceded by emotional disorders, psychotic symptoms, depressive symptoms, impaired functioning prior patient, acute anxiety and agitation, which occurs about two weeks before. Subsequently choreiform stereotypies, primitive hyperkinesias, spasms and rhythmic and cyclic arm movements. In catatonia, hyperactivity and hyperthermia typically occur prior to the administration of the neuroleptic.