Neuroleptic malignant syndrome (NMS) is rare, but potentially lethal complication associated with the use of neuroleptic agents. NMS is most often observed after high-potency first-generation neuroleptic agents. NMS is characterised by a distinctive clinical syndrome including: hyperthermia, muscular rigidity, mental status change, autonomic disability. The most common laboratory finding is elevated serum CK. The management of patients with NMS demands aggressive care and discontinuing of the causative agent.
A 49-year-old patient with recurrent depressive disorders is presented. NMS developed following the increase in haloperidol dose and concomitant use of olanzapine. The treatment with bromocriptine and lorazepam resulted in a prompt recovery.

neuroleptic malignant syndrome; hyperthermia; elevated serum CK

Velamoor VR. Neuroleptic malignant syndrome. Recognition, prevention and management. Drug Saf 1998; 19:73.

Caroff SN, Mann SC. Neuroleptic malignant syndrome. Med Clin North Am 1993; 77:185.

Modi S, Dharaiya D, Schultz L, Varelas P. Neuroleptic Malignant Syndrome: Complications, Outcomes, and Mortality. Neurocrit Care 2016; 24:97.

Margetić B, Aukst-Margetić B. Neuroleptic malignant syndrome and its controversies. Pharmacoepidemiol Drug Saf 2010; 19:429.

Berardi D, Amore M, Keck PE Jr, et al. Clinical and pharmacologic risk factors for neuroleptic malignant syndrome: a case-control study. Biol Psychiatry 1998; 44:748.

Tanii H, Taniguchi N, Niigawa H, et al. Development of an animal model for neuroleptic malignant syndrome: heat-exposed rabbits with haloperidol and atropine administration exhibit increased muscle activity, hyperthermia, and high serum creatine phosphokinase level. Brain Res 1996; 743:263.

Boulant JA. Role of the preoptic-anterior hypothalamus in thermoregulation and fever. Clin Infect Dis 2000; 31 Suppl 5:S157.

Waldorf S. AANA journal course. Update for nurse anesthetists. Neuroleptic malignant syndrome. AANA J 2003; 71:389.

Velamoor VR, Norman RM, Caroff SN, et al. Progression of symptoms in neuroleptic malignant syndrome. J Nerv Ment Dis 1994; 182:168.

Hermesh H, Manor I, Shiloh R, et al. High serum creatinine kinase level: possible risk factor for neuroleptic malignant syndrome. J Clin Psychopharmacol 2002; 22:252.

Gurrera RJ, Caroff SN, Cohen A, et al. An international consensus study of neuroleptic malignant syndrome diagnostic criteria using the Delphi method. J Clin Psychiatry 2011; 72:1222.

Carbone JR. The neuroleptic malignant and serotonin syndromes. Emerg Med Clin North Am 2000; 18:317.

Caroff SN, Rosenberg H, Fletcher JE, et al. Malignant hyperthermia susceptibility in neuroleptic malignant syndrome. Anesthesiology 1987; 67:20.

Caroff SN, Mann SC, Keck PE Jr. Specific treatment of the neuroleptic malignant syndrome. Biol Psychiatry 1998; 44:378.

Sarkar S, Gupta N. Drug information update. Atypical antipsychotics and neuroleptic malignant syndrome: nuances and pragmatics of the association. BJPsych Bull 2017; 41:211.

Lappa A, Podestà M, Capelli O, et al. Successful treatment of a complicated case of neuroleptic malignant syndrome. Intensive Care Med 2002; 28:976.

Pileggi DJ, Cook AM. Neuroleptic Malignant Syndrome. Ann Pharmacother 2016; 50:973.

Rosebush PI, Stewart T, Mazurek MF. The treatment of neuroleptic malignant syndrome. Are dantrolene and bromocriptine useful adjuncts to supportive care? Br J Psychiatry 1991; 159:709.