Complex and Prolonged Clinical Course of Neuroleptic Malignant Syndrome With Persistent Catatonic Features: A Case Report

Document Type

Article

Publication Title

American Journal of Psychiatry Residents' Journal

Abstract

Neuroleptic malignant syndrome (NMS) is characterized by muscle rigidity, altered mental status (AMS), and autonomic instability. The incidence rate of NMS is estimated to be between 0.01% and 0.11% among patients taking neuroleptic medications (1, 2). Fatalities due to NMS, although rare, are often caused by arrhythmia, disseminated intravascular coagulation, or respiratory or renal failure (2). Risk factors for developing NMS include polypharmacy, high-potency antipsychotic medications, tricyclic antidepressants, metoclopramide, and tetrabenazine. Withdrawal of dopaminergic medications such as levodopa or amantadine may also trigger NMS. Although it is common to diagnose NMS, malignant catatonia, and serotonin syndrome as distinct entities (3), authors of some recent studies (4) have suggested that these syndromes can also overlap and exist on a spectrum, complicating diagnosis and treatment. Some authors have also highlighted atypical presentations of NMS (5). The case we discuss here illustrates the challenging nature of distinguishing NMS from other overlapping clinical syndromes, particularly among patients with intellectual disability. We also highlight the risks of polypharmacy in precipitating NMS and catatonia and the usefulness of electroconvulsive therapy (ECT) in managing catatonia associated with NMS and antipsychotic medication use.

DOI

10.1176/appi.ajp-rj.2026.220102

Publication Date

9-3-2026

ISSN

2474-4662

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