NEUROLEPTIC MALIGNANT SYNDROME: A SIXTEEN YEARS RETROSPECTIVE REVIEW

Abstract

Objective: To study demographic characteristics, psychiatric diagnosis, type of neuroleptic drugs administered, course of illness, management and outcome.
Design: Retrospective chart review study.
Place and duration of study: This study was carried out for sixteen years (1988-2004) in the Psychiatry
unit, Aga Khan University Hospital, Karachi.
Subjects and Methods: Sample consisted of 25 cases of Neuroleptic Malignant Syndrome in which 13
were males and 12 were females. The record was taken from the health information management system
which keeps a comprehensive chart of each patient. This renders the files retrievable through computer
generated search. A specific data collection form was designed for extraction of relevant data. The data
was analyzed using SPSS version 13.0.
Results: Twenty five cases were identified, of which thirteen were males. Mean age was 45 years (range
20-74 years). Bipolar affective disorder was the most common diagnosis followed by schizo-affective
disorder, schizophrenia, postpartum psychosis, dementia and Parkinsonism. 48% of the patients had
previous history of neuroleptic use, while 28% received neuroleptics for the first time. Among neuroleptic
users, 20% were on long-acting depot antipsychotics. 52% received per-oral dose (PO), while 32% received intramuscular (IM) dose. 56% patients were on other concomitant medications among which Lithium
was the most common (16%). 96% patients had the cardinal symptoms of fever, rigidity and increased
creatine phosphokinase (CPK). 96% had associated delirium, 80% showed autonomic instability with
fluctuation in pulse and blood pressure. Electrolyte disturbance was seen in 84% and diaphoresis with
leukocytosis was present in 68% patients. NMS was associated with high ambient temperature with mean
temperature of 39.20
C (S.E. 0.3). Discontinuation of neurolpetic medications and supportive care was
carried out in all cases. In our case series we observed mortality rate of 16%. Out of 25 patients, 21
recovered with early diagnosis and adequate management.
Conclusion: Risk of NMS can be minimized by use of low potency or atypical antipsychotics, cautious
use of concomitant medications and depot preparations and initiation of neurolpetics at lower dose with
careful monitoring. With good supportive medical care mortality can be substantially mimimized.
Key words: Neuroleptic malignant syndrome (NMS), neuroleptics, creatine phosphokinase (CPK).