Catatonic variants, hyperthermic extrapyramidal reactions, and subtypes of neuroleptic malignant syndrome.
BACKGROUND
This case series study examines the hypothesis that neuroleptic malignant syndrome (NMS) is a heterogeneous condition including catatonic variants and non-catatonic pathological reactions to antipsychotics.


METHODS
Fourteen episodes of NMS were prospectively identified. Patients were examined for catatonia during the course of NMS. Close monitoring of catatonia episodes and suspected cases of evolving NMS for possible NMS development provided data on the pre-NMS clinical course. All NMS episodes received benzodiazepines. Episodes with catatonia diagnosed were compared with those without catatonia, noting their presentation, clinical course and responses to treatment.


RESULTS
Concurrent catatonia was diagnosed in 9 episodes. In 6 of them antecedent catatonia progressed to NMS following antipsychotic exposure (NMS of antipsychotic-converted catatonia). In 3 episodes, a parkinsonian-catatonic syndrome with fever and autonomic abnormality developed in reaction to antipsychotics (NMS of antipsychotic-induced catatonia). Catatonia was not diagnosed in 5 during the longitudinal course of NMS. A severe extrapyramidal reaction to antipsychotics with associated delirium preceded all 5 episodes. Seven of the 9 NMS episodes with catatonia and none of the 5 without catatonia showed significant responses to benzodiazepines.


CONCLUSIONS
The preliminary findings support the hypothesis that NMS is a heterogeneous condition including catatonic variants and non-catatonic hyperthermic extrapyramidal reactions to antipsychotics, differing in presentation, clinical course, and treatment responses.
Lee
Joseph W Y
JW
Graylands Hospital and School of Psychiatry and Clinical Neurosciences, University of Western Australia, Australia. Joseph.Lee@health.wa.gov.au
D000293:Adolescent; D000328:Adult; D000647:Amnesia / Q000175:diagnosis / Q000188:drug therapy; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001480:Basal Ganglia Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D001569:Benzodiazepines / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy; D002389:Catatonia / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D003693:Delirium / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy; D003937:Diagnosis, Differential; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008305:Malignant Hyperthermia / Q000175:diagnosis* / Q000188:drug therapy; D009459:Neuroleptic Malignant Syndrome / Q000175:diagnosis* / Q000188:drug therapy; D009460:Neurologic Examination / Q000187:drug effects; D020734:Parkinsonian Disorders / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy*; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy
D014150:Antipsychotic Agents; D001569:Benzodiazepines