Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-23T23:09:29.391Z Has data issue: false hasContentIssue false
  • English
  • Français

Neuroleptic malignant syndrome: risk factors, pathophysiology, and treatment

Published online by Cambridge University Press:  24 June 2014

Jambur Ananth ,
Kamala Aduri ,
Sharath Parameswaran  and
Sarath Gunatilake
Jambur Ananth*
Affiliation:
Department of Psychiatry, Harbor-UCLA Medical Center, Torrance Metropolitan State Hospital, Norwalk, CA, USA
Kamala Aduri
Affiliation:
Department of Psychiatry, Harbor-UCLA Medical Center, Torrance
Sharath Parameswaran
Affiliation:
Metropolitan State Hospital, Norwalk, CA, USA
Sarath Gunatilake
Affiliation:
Metropolitan State Hospital, Norwalk, CA, USA
*
Dr Jambur Ananth, Professor of Psychiatry, Department of Psychiatry, Harbor-UCLA Medical Center, 1000 West Carson Street, F-9, Torrance, CA 90502, USA. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Neuroleptic malignant syndrome (NMS) is associated with the administration of antipsychotic agents and other drugs such as l-dopa, antidepressants, and antihistaminic agents. Unexpected changes in mental status, new-onset catatonia, episodic tachycardia, tachypnea, hypertension, dysarthria, dysphagia, diaphoresis, sialorrhea, incontinence, low-grade temperature elevations, and rigidity should arouse suspicion. Several lines of evidence provide support for the involvement of dopamine. Most of the drugs implicated in NMS are D2 dopamine receptor antagonists. Central noradrenergic activity is also possibly related to the disorder, as sympathetic hyperactivity is associated with the active phase of NMS. Currently, the definitive role of GABA deficiency in NMS is yet to be established. Differential diagnosis should include malignant hyperthermia, lethal catatonia, lithium toxicity, serotonin syndrome, and heat stroke. A high degree of suspicion and the discontinuation of antipsychotic agents even if the diagnosis is not established are essential for the safety of the patient. Treatment of NMS should be individualized and be based empirically on the character, duration, and severity of the clinical signs and symptoms noted. The initial step in the treatment of NMS is the removal of the offending agent. Full-blown NMS is a serious condition and requires immediate supportive, nutritive, and electrolyte therapies. The administration of drugs that can improve NMS, such as IV dantrolene and/or oral bromocriptine, may also be taken into consideration, based on the severity and nature of the NMS.

Keywords

antipsychotic drugs and neuroleptic malignant syndromeneuroleptic malignant syndromepathophysiology of neuroleptic malignant syndromerisk factors of neuroleptic malignant syndrometreatment of neuroleptic malignant syndrome
Type
Original Article
Information
Acta Neuropsychiatrica , Volume 16 , Issue 4 , August 2004 , pp. 219 - 228
Copyright
Copyright © 2004 Blackwell Munksgaard

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Delay, J, Pichot, P, Lemperiere, Tet al. Un neuroleptique majeur non phenothiazine et non reserpine, 1 ‘haloperidol, dans le traitement des psychoses [Haloperidol, a nonphenothiazine, nonreserpine neuroleptic for the treatment of psychosis]. Annales Med-Psychologiques 1960;118: 145–152. Google Scholar
Khan, M, Farver, D. Recognition, assessment and management of neuroleptic malignant syndrome. S D J Med 2000;53(9):395–400. Google ScholarPubMed
Keck, PE Jr, Pope, HG, McElroy, SL. Frequency and presentation of neuroleptic malignant syndrome: a prospective study. Am J Psychiatry 1987;144: 1344–1366. Google ScholarPubMed
Bernardi, D, Amore, M, Keck, P Jret al. Clinical and pharmacologic risk factors for neuroleptic malignant syndrome: a case-control study. Biol Psychiatry 1998;44: 748–754. CrossRefGoogle Scholar
Fawcett, J. How do we keep our eyes open? Psychiatric Ann 2000;30: 304. CrossRefGoogle Scholar
Caroff, SN. The neuroleptic malignant syndrome. J Clin Psychiatry 1980;41: 79–83. Google ScholarPubMed
Susman, VL. Clinical management of neuroleptic malignant syndrome. Psychiatr Q 2001;72(4):325–336. CrossRefGoogle ScholarPubMed
Addonizio, G, Susman, VL, Roth, SD. Neuroleptic malignant syndrome: review and analysis of 115 cases. Biol Psychiatry 1987;22: 1004–1020. CrossRefGoogle ScholarPubMed
Shalev, A, Munitz, H. The neuroleptic malignant syndrome: agent and host interaction. Acta Psychiatr Scand 1986;73: 337–347. CrossRefGoogle ScholarPubMed
Rosebush, P, Stewart, T. A prospective analysis of 24 episodes of neuroleptic malignant syndrome. Am J Psychiatry 1989;146: 717–725. Google ScholarPubMed
Keck, PE, Pope, HG, McElroy, SL. Declining frequency of neuroleptic malignant syndrome in a hospital population. Am J Psychiatry 1991;148: 880–882. Google Scholar
Toru, M, Matsuda, O, Makiguchi, K, Sugano, K. Neuroleptic malignant syndrome-like state following a withdrawal of anti-parkinsonian drugs. J Nerv Ment Dis 1981;169: 324–327. CrossRefGoogle Scholar
Friedman, JH, Feinberg, SS, Feldman, RG. A neuroleptic malignant-like syndrome due to levodopa therapy withdrawal. JAMA 1985;254: 2792–2795. CrossRefGoogle Scholar
Yamawaki, Y, Ogawa, N. Successful treatment of levodopa-induced neuroleptic malignant syndrome (NMS) and disseminated intravascular coagulation (DIC) in a patient with Parkinson's disease. Intern Med 1992;31: 1298–1302. CrossRefGoogle Scholar
Gordon, PH, Fruct, SJ. Neuroleptic malignant syndrome in advanced Parkinson's disease. Mov Disord 2001;16(5):960–974. CrossRefGoogle ScholarPubMed
Ito, T, Shibata, K, Watanabe, Aet al. Neuroleptic malignant syndrome following withdrawal of amantadine in a patient with influenza: a encephalopathy. Eur J Pediatr 2001;160(6):401. CrossRefGoogle Scholar
De Montigny, C, Cournoyer, G, Morissette, R, Langlois, R, Caille, G. Lithium carbonate addition in tricyclic anti-depressant-resistant unipolar depression. Arch Gen Psychiatry 1983;40: 1327–1334. CrossRefGoogle ScholarPubMed
Assion, HJ, Heinemann, F, Laux, G. Neuroleptic malignant syndrome under treatment with antidepressants? A critical review. Eur Arch Psychiatry Clin Neurosci 1998;248: 231–239. CrossRefGoogle ScholarPubMed
Cohen, BM, Harris, PQ, Altesman, RLet al. Neuroleptic as well as an antidepressant? Am J Psychiatry 1982;139: 1165–1167. Google ScholarPubMed
Thornton, JE, Stahl, SM. Case report of tardive dyskinesia and parkinsonism associated with amoxapine therapy. Am J Psychiatry 1984;141(5):704–705. Google ScholarPubMed
Lydiard, RB, Gelenberg, AJ. Amoxapine: an antidepressant with some neuroleptic properties? A review of its chemistry, animal pharmacology and toxicology, human pharmacology and clinical efficacy. Pharmacotherapy 1981;1: 163–178. CrossRefGoogle ScholarPubMed
Ansseau, M, Reynolds, CF III, Kupfer, DJet al. Central dopaminergic and noradrenergic receptor blockade in a patient with neuroleptic malignant syndrome. J Clin Psychiatry 1986;47(6):320–321. Google Scholar
Langlow, JR, Alarcon, RD. Trimipramine-induced neuroleptic malignant syndrome after transient psychogenic polydipsia in one patient. J Clin Psychiatry 1989;50: 144–145. Google ScholarPubMed
Madakasira, S. Amoxapine-induced neuroleptic malignant syndrome. Ann Pharmacother 1989;23: 50–52. Google ScholarPubMed
Sumyoshi, A, Oguchi, T, Takahashi, Aet al. Two cases of syndrome malin induced by tricyclic antidepressants. Seishin Shinkeigaku Zasshi 1982;36: 461–462. Google Scholar
June, R, Meraj, Y, Gossman, W. Neuroleptic malignant syndrome associated with nortriptyline. Am J Emerg Med 1999;17: 736–737. CrossRefGoogle ScholarPubMed
Aydin, N, Anac, E, Caykoylu, Aet al. Neuroleptic malignant syndrome due to citalopram overdose. Can J Psychiatry 2000;45(10):941–942. Google ScholarPubMed
Baldessarini, RJ, Marsh, E. Fluoxetine and side effects. Arch Gen Psychiatry 1990;47: 191–192. CrossRefGoogle ScholarPubMed
Carter, CJ, Pycock, CJ. Possible importance of 5-hydroxytryptamine in neuroleptic-induced catalepsy in rats [proceedings]. Br J Pharmacol 1977;60(2): 267P–268P. Google Scholar
Corrigan, FM, Coulter, F. Neuroleptic malignant syndrome, amitriptyline and thioridazine. Biol Psychiatry 1988;23: 320–321 . CrossRefGoogle ScholarPubMed
Velamoor, VR. NMS complicated by diazepam. Br J Psychiatry 1992;160: 135–136. CrossRefGoogle ScholarPubMed
Menza, MA, Harris, D. Benzodiazepines and catatonia: an overview. Biol Psychiatry 1989;26(8):842–846. CrossRefGoogle ScholarPubMed
Larner, AJ, Smith, SC, Farmer, SF. ‘Non-neuroleptic malignant’ syndrome. J Neurol Neurosurg Psychiatry 1998;65(4):613. CrossRefGoogle Scholar
Samson-Fang, L, Norlin, C. Intrathecal baclofen withdrawal simulating neuroleptic malignant syndrome in a child with cerebral palsy. Dev Med Child Neurol 2000;42(8):561–565. CrossRefGoogle Scholar
Park-Matsumoto, YC, Tazawa, T. Neuroleptic malignant syndrome associated with diphenhydramine and diprophyllin overdose in a depressed patient. J Neurol Sci 1999;162: 108–109. Google Scholar
Chan-Tack, KM. Neuroleptic malignant syndrome due to promethazine. South Med J 1999;92: 1017–1018. CrossRefGoogle ScholarPubMed
Ehara, H, Maegaki, Y, Takeshita, K. Neuroleptic malignant syndrome and methylphenidate. Pediatr Neurol 1998;19: 299–301. CrossRefGoogle ScholarPubMed
Edgar, J. Droperidol-induced neuroleptic malignant syndrome. Hosp Med 1999;60: 448–450. CrossRefGoogle ScholarPubMed
Nimmagadda, SR, Ryan, DH, Atkin, SL. Neuroleptic malignant syndrome after venlafaxine. Lancet 2000; 355(9200):289–290. CrossRefGoogle ScholarPubMed
Caroff, SN, Mann, SC. Neuroleptic malignant syndrome. Psychopharmacol Bull 1988;24: 25–29. Google ScholarPubMed
Lazarus, A, Mann, SC, Caroff, SN. The neuroleptic malignant syndrome and related conditions. Washington, DC: American Psychiatric Press, 1989. Google Scholar
Itoh, H, Ohtsuka, N, Ogita, Ket al. Malignant neuroleptic syndrome: its present status in Japan and clinical problems. Seishin Shinkeigaku Zasshi 1977; 31: 565–576. Google ScholarPubMed
Harsch, HH. Neuroleptic malignant syndrome: physiological and laboratory findings in a series of nine cases. J Clin Psychiatry 1987;48: 328–333. Google Scholar
Peloreno, AL, Levenson, JL, Pandurangi, AK. Neuroleptic malignant syndrome: a review. Psychiatr Serv 1988;49(9):1163–1172. Google Scholar
Treloar, AJ, Crook, MA, Tuff, Pet al. Iron status, movement disorders, and acute phase response in elderly psychotic patients. J Neurol Neurosurg Psychiatry 1994;57: 208–210. CrossRefGoogle Scholar
Hermesh, H, Manor, I, Shiloh, Ret al. High serum creatinine kinase level: possible risk factor for neuroleptic malignant syndrome. J Clin Psychopharmacol 2002;22(3):252–256. CrossRefGoogle ScholarPubMed
Caroff, SN, Mann, SC. Neuroleptic malignant syndrome. Med Clin North Am 1993;77: 185–202. CrossRefGoogle ScholarPubMed
Levensen, JL. Neuroleptic malignant syndrome. Am J Psychiatry 1985;142(10):1137–1145. Google Scholar
Ueda, M, Hamamoto, M, Nagayama, Het al. Susceptibility to neuroleptic malignant syndrome in Parkinson's disease. Neurology 1999;52: 777–781. CrossRefGoogle ScholarPubMed
Akpaffiong, MJ, Ruiz, P. Neuroleptic malignant syndrome: a complication of neuroleptics and cocaine abuse. Psychiatr Q 1991;62: 299–309. CrossRefGoogle ScholarPubMed
Kosten, TR, Kleber, HD. Rapid death during cocaine abuse: a variant of the neuroleptic malignant syndrome? Am J Drug Alcohol Abuse 1988;14: 335–346. CrossRefGoogle ScholarPubMed
Deuschl, G, Oepen, G, Hermle, L. Neuroleptic malignant syndrome: observations on altered consciousness. Pharmacopsychiatry 1987;20: 168–170. CrossRefGoogle ScholarPubMed
Otani, K, Horiuchi, M, Kondo, Tet al. Is the predisposition to neuroleptic malignant syndrome genetically transmitted? Br J Psychiatry 1991;158: 850–853. CrossRefGoogle ScholarPubMed
Lazarus, AL, Moore, KE, Spinner, NB. Recurrent neuroleptic malignant syndrome associated with inv dup(15) and mental retardation. Clin Genet 1991;39: 65–67. CrossRefGoogle ScholarPubMed
Kawanishi, C, Furono, T, Onishi, Het al. Lack of association in Japanese patients between neuroleptic malignant syndrome and a debrisoquine 4-hydroxylase genotype with low enzyme activity. Psychiatr Genet 2000;10(3):145–147. CrossRefGoogle Scholar
Ram, A, Cao, Q, Keck, PEet al. Structural change in dopamine D2 receptor gene in a patient with neuroleptic malignant syndrome. Am J Med Genet 1995;60: 228–230. CrossRefGoogle Scholar
Suzuki, A, Kondo, T, Otani, Ket al. Association of TaqI A polymorphism of the dopamine D2 receptor gene with predisposition to neuroleptic malignant syndrome. Am J Psychiatry 2001;158: 1714–1716. CrossRefGoogle Scholar
Kawanishi, C, Hanihara, T, Shimoda, Yet al. Lack of association between neuroleptic malignant syndrome and polymorphisms in the 5-HT1A and 5-HT2A receptor genes. Am J Psychiatry 1998;155: 1275–1277. CrossRefGoogle ScholarPubMed
Kawanishi, C, Shimoda, Y, Fuzimaki, Jet al. Mutation involving cytochrome P450IID6 in two Japanese patients with neuroleptic malignant syndrome. J Neurol Sci 1998;160(1):102–104. CrossRefGoogle ScholarPubMed
Caroff, SN, Mann, SC, Lazarus, Aet al. Neuroleptic malignant syndrome: diagnostic issues. Psychiatric Ann 1991;21: 130–147. CrossRefGoogle Scholar
Moyes, DG. Malignant hyperpyrexia caused by trimeprazine. Br J Anaesth 1973;45: 1163–1164. CrossRefGoogle ScholarPubMed
Boles, JM, Lecam, B, Mialon, P, Pennec, Y, Garre, M. Hyperthermie maligne des neuroleptiques: guérison rapide par le dantrolene. La Nouvelle Presse Medicale 1982;11: 674. Google Scholar
Yamawaki, S, Yano, E, Terakawa, Net al. On the results of a nationwide survey on neuroleptic malignant syndrome. Masui Sosei 1988;24(Suppl. 19):52–67. Google Scholar
Yamawaki, S, Yano, E, Uchitomi, Yet al. Analysis of 497 cases of neuroleptic malignant syndrome in Japan. Masui Sosei 1990;26: 35–44. Google Scholar
Peiris, DT, Kuruppuarachchi, K, Weerasena, LPet al. Neuroleptic malignant syndrome without fever: a report of three cases. J Neurol Neurosurg Psychiatry 2000;69(2):277–278. CrossRefGoogle ScholarPubMed
Haggarty, JM, Husni, M, Peat, Cet al. Atypical neuroleptic malignant syndrome? Can J Psychiatry 1999;44(7):711–712. Google ScholarPubMed
Misiaszek, JJ, Potter, RL. Atypical neuroleptic malignant syndrome responsive to conservative management. Psychosomatics 1985;26: 62–66. CrossRefGoogle ScholarPubMed
Lee, JWY. Catatonic and non-catatonic neuroleptic malignant syndrome. Aust N Z J Psychiatry 2000;34(5): 877. CrossRefGoogle ScholarPubMed
Mann, SC, Caroff, SN, Lazarus, A. Pathogenesis of neuroleptic malignant syndrome. Psychiatric Ann 1991;21: 175–180. CrossRefGoogle Scholar
Sakkas, P, Davis, JM, Janicak, PGet al. Drug treatment of neuroleptic malignant syndrome. Psychopharmacol Bull 1991;27: 381–384. Google ScholarPubMed
Kapur, S, Zipursky, RB, Remington, G. Clinical and theoretical implications of 5-HT2 and D2 receptor occupancy of clozapine, risperidone, and olanzapine in schizophrenia. Am J Psychiatry 1999;156: 286–293. Google Scholar
Greenberg, LB, Gujavarty, K. The neuroleptic malignant syndrome: review and report of three cases. Compr Psychiatry 1985;26: 63–70. CrossRefGoogle ScholarPubMed
Fink, M. Neuroleptic malignant syndrome and catatonia: one entity or two? Biol Psychiatry 1996;39: 1–4. CrossRefGoogle ScholarPubMed
Tollefson, G. A case of neuroleptic malignant syndrome: in vitro muscle comparison with malignant hyperthermia. J Clin Psychopharmacol 1982;2: 266–270. CrossRefGoogle ScholarPubMed
Miyatake, R, Iwanashi, K, Matsushita, Met al. No association between the neuroleptic malignant syndrome and mutations in the RYR1 gene associated with malignant hyperthermia. J Neurol Sci 1996;143: 161–165. CrossRefGoogle ScholarPubMed
Feibel, JH, Schiffer, RB. Sympathoadrenomedullary hyperactivity in the neuroleptic malignant syndrome: a case report. Am J Psychiatry 1981;138: 1115–1116. Google ScholarPubMed
Gurrera, RJ, Romero, J. Sympathoadrenomedullary activity in neuroleptic malignant syndrome. Biol Psychiatry 1992;32: 334–343. CrossRefGoogle ScholarPubMed
Gurrera, RJ. Sympathoadrenal hyperactivity and the etiology of neuroleptic malignant syndrome. Am J Psychiatry 1999;156: 169–180. Google ScholarPubMed
Morris, HH III, McCormick, WF, Reinarz, JA. Neuroleptic malignant syndrome. Arch Neurol 1980;37: 462–463. CrossRefGoogle ScholarPubMed
Conlon, P. The spectrum concept of neuroleptic toxicity. Am J Psychiatry 1986;143: 811. Google ScholarPubMed
Dhib-Jalbut, S, Hesselbrock, R, Mouradian, MMet al. Bromocriptine treatment of neuroleptic malignant syndrome. J Clin Psychiatry 1987;48: 69–73. Google ScholarPubMed
Price, DK, Turnbull, GJ, Gregory, RPet al. Neuroleptic malignant syndrome in a case of postpartum psychosis. Br J Psychiatry 1989;155: 849–852. CrossRefGoogle Scholar
Gurrera, RJ, Chang, SS. Thermoregulatory dysfunction in neuroleptic malignant syndrome. Biol Psychiatry 1996;39: 207–212. CrossRefGoogle ScholarPubMed
Kurlan, R, Hamill, R, Shoulson, I. Review: neuroleptic malignant syndrome. Clin Neuropharmacol 1984;7: 109–120. CrossRefGoogle ScholarPubMed
Goldwasser, HD, Hooper, JF, Spears, NM. Concomitant treatment of neuroleptic malignant syndrome and psychosis. Br J Psychiatry 1989;154: 102–104. CrossRefGoogle ScholarPubMed
Hoffman, WH, Chodoroff, G, Piggot, LR. Haloperidol and thyroid storm. Am J Psychiatry 1978;135: 484–486 (correction, 135:762).Google ScholarPubMed
Schibuk, M, Schacter, D. A role for catecholamines in the pathogenesis of neuroleptic malignant syndrome. Can J Psychiatry 1986;31: 66–69. CrossRefGoogle ScholarPubMed
Murao, S, Ogawa, N, Ishibe, Yet al. Neuroleptic malignant syndrome associated with droxidopa in a patient with striatonigral degeneration. Res Com Psychol Psychiatry Behav 1993;18: 13–18. Google Scholar
Keshavan, MS, Stecker, J, Kambhambati, RK. Creatinine kinase elevations with clozapine. Br J Psychiatry 1994;164: 118–120. CrossRefGoogle Scholar
Gurrera, R, Romero, J. Enzyme elevations in the neuroleptic malignant syndrome. Biol Psychiatry 1993;34: 634–640. CrossRefGoogle ScholarPubMed
Pappas, NJ Jr. Theoretical aspects of enzymes in diagnosis: why do serum enzymes change in hepatic, myocardial and other diseases? Clin Lab Med 1989;9: 595–626. Google ScholarPubMed
Lew, TY, Tollefson, G. Chlorpromazine-induced neuroleptic malignant syndrome and its response to diazepam. Biol Psychiatry 1983;18(12):1441–1446. Google ScholarPubMed
Kornhuber, J, Kornhuber, ME. Presynaptic dopaminergic modulation of cortisol input into the striatum. Life Sci 1986;39: 669–674. CrossRefGoogle Scholar
Weller, M, Kornhuber, J. A rationale for NMDA receptor antagonist therapy of neuroleptic malignant syndrome. Med Hypotheses 1992;38: 329–333. CrossRefGoogle ScholarPubMed
Frandsen, A, Schousboe, A. Dantrolene prevents glutamate cytotoxicity and Ca2+ release from intracellular stores in cultured cerebral cortical neurons. J Neurochem 1991;56: 1075–1078. CrossRefGoogle ScholarPubMed
Osman, AA, Khurasani, MH. Lethal catatonia and neuroleptic malignant syndrome: a dopamine receptor shut-down hypothesis. Br J Psychiatry 1994;165: 548–550. CrossRefGoogle ScholarPubMed
Fink, M, Taylor, MA. The many varieties of catatonia. Eur Arch Psychiatry Clin Neurosci 2001;251(Suppl. 1): 1/8–1/13. CrossRefGoogle ScholarPubMed
Mann, SC, Caroff, SN, Bleir, HRet al. Lethal catatonia. Am J Psychiatry 1986;143: 1374–1381. Google ScholarPubMed
Northoff, G, Wenke, J, Pflug, B. Increase of serum creatinine phosphokinase in catatonia: an investigation in 32 acute catatonic patients. Psychol Med 1996;26: 547–553. CrossRefGoogle Scholar
Rosebush, PI, Mazurek, MF. Serum iron and neuroleptic malignant syndrome. Lancet 1991;338: 149–151. CrossRefGoogle ScholarPubMed
Castillo, E, Rubin, RT, Halsboer-Trachsler, E. Clinical differentiation between lethal catatonia and neuroleptic malignant syndrome. Am J Psychiatry 1989;146: 324–328. Google ScholarPubMed
Francis, A, Divadeenam, K, Petrides, G. Advances in the diagnosis and treatment of catatonia. Convuls Ther 1997;12: 259. Google ScholarPubMed
Gurrera, RJ. Is neuroleptic malignant syndrome a neurogenic form of malignant hyperthermia? Clin Neuropharmacol 2002;25: 1831–1893. CrossRefGoogle ScholarPubMed
Keck, PE Jr, Caroff, SN, McElroy, SL. Neuroleptic malignant syndrome and malignant hyperthermia: end of a controversy? J Neuropsychiatry Clin Neurosci 1995;7: 135–144. Google ScholarPubMed
Schou, M. Long-lasting neurological sequelae after lithium intoxication. Acta Psychiatr Scand 1984;70: 594–602. CrossRefGoogle ScholarPubMed
Sansone, ME, Ziegler, DK. Lithium toxicity: a review of neurologic complications. Clin Neuropharmacol 1985;8: 242–248. CrossRefGoogle ScholarPubMed
Addonizio, G. Rapid induction of extrapyramidal side effects with combined use of lithium and neuroleptics. J Clin Psychopharmacol 1985;5: 296–298. CrossRefGoogle ScholarPubMed
Velamoor, VR, Swamy, GN, Parmar, RSet al. Management of suspected neuroleptic malignant syndrome. Can J Psychiatry 1995;40: 545–550. CrossRefGoogle ScholarPubMed
Scheftner, WA, Sculman, RB. Treatment choice in neuroleptic malignant syndrome. Convuls Ther 1992; 8: 267–279. Google ScholarPubMed
Nolen, WA, Zwaan, WA. Treatment of lethal catatonia with electroconvulsive therapy and dantrolene sodium: a case report. Acta Psychiatr Scand 1990;82: 90–92. CrossRefGoogle ScholarPubMed
Pennati, A, Sacchetti, E, Calzeroni, A. Dantrolene in lethal catatonia. Am J Psychiatry 1991;148: 268. Google ScholarPubMed
Kelft, EV, Dehert, M, Heytens, Let al. Management of lethal catatonia with dantrolene sodium. Crit Care Med 1991;19: 1449–1451. CrossRefGoogle ScholarPubMed
Philbrick, KL, Rummans, TA. Malignant catatonia. J Neuropsychiatry 1994;6: 1–13. Google ScholarPubMed
Mann, SC, Caroff, SN, Bleir, HRet al. Electroconvulsive therapy of the lethal catatonia syndrome: case report and review. Convuls Ther 1990; 6: 239–247. Google Scholar