Neuroleptic malignant Syndrome Risk and Prognostic Factors
Neuroleptic malignant Syndrome Risk and Prognostic Factors
Neuroleptic malignant syndrome is a potential risk in any individual after antipsychotic drug administration. It is not specific to any neuropsychiatric diagnosis and may occur in individuals without a diagnosable mental disorder who receive dopamine antagonists. Clinical, systemic, and metabolic factors associated with a heightened risk of neuroleptic malignant syndrome include agitation, exhaustion, dehydration, and iron deficiency(Rosebush and Mazurek 1991; Keck et al. 1989; Sachdev et al. 1997). A prior episode associated with antipsychotics has been described in 15%–20% of index cases, suggesting underlying vulnerability in some patients(Caroff and Mann 1988; Yamawaki et al. 1990); however, genetic findings based on neurotransmitter receptor polymorphisms have not been replicated consistently.
Nearly all dopamine antagonists have been associated with neuroleptic malignant syndrome, although high-potency antipsychotics pose a greater risk compared with low-potency agents and newer atypical antipsychotics(Ananth et al. 2004; Hasan and Buckley 1998; Stübner et al. 2004; Yacoub and Francis 2006). Partial or milder forms may be associated with newer antipsychotics, but neuroleptic malignant syndrome varies in severity even with older drugs. Dopamine antagonists used in medical settings (e.g., metoclopramide, prochlorperazine) have also been implicated. Parenteral administration routes, rapid titration rates, and higher total drug dosages have been associated with increased risk(Keck et al. 1989; Sachdev et al. 1997); however, neuroleptic malignant syndrome usually occurs within the therapeutic dosage range of antipsychotics.
