Neuroleptic malignant syndrome

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The neuroleptic malignant syndrome (NMS) is an idiosyncratic reaction to neuroleptic agents that consists of fever, mental status changes, muscle rigidity, autonomic dysfunction, respiratory distress, and rhabdomyolysis. This potentially lethal disease is not widely recognized and is probably underdiagnosed, but early recognition and therapy may decrease morbidity and mortality. The authors summarize the major features of NMS and review supportive therapy and specific investigational treatment with anticholinergics, muscle relaxants, and dopamine agonists. They also offer guidelines for restarting therapy with neuroleptics in patients recovering from NMS.