Intended for healthcare professionals

Rapid response to:

Clinical Review Lesson of the week

Clomipramine induced neuroleptic malignant syndrome and pyrexia of unknown origin

BMJ 2004; 329 doi: (Published 02 December 2004) Cite this as: BMJ 2004;329:1333

Rapid Response:

Treat TSS and NMS as Maligant Catatonia

Haddow et al. describe the neuroleptic malignant syndrome and the
toxic serotonin syndrome as identical clinical toxic responses with
different precipitants. The number of precipitants are many, not only
within the classes of modern antipsychotic and antidepressant drugs.
Indeed, NMS and TSS are not distinguishable from malignant catatonia, a
syndrome that was recognized before the modern psychotropic drug era (Fink
and Taylor, 2003).

While the majority of such toxic reactions respond to withdrawal of
the toxic agent and supportive measures, the authors rightly note that
morbidity and mortality are still severe. Recognizing NMS and TSS as
examples of MC allows the treatment for MC to be considered after
discontinuation of the toxic agent. MC is effectively treated with
sedative anticonvulsants (barbiturates, benzodiazepines) and when these
fail, with induced seizures (ECT).

An important precipitating factor in this syndrome is dehydration and
restoring fluid balance is also essential to effective relief.

Fink M, Taylor MA. CATATONIA: A Clinician's Guide to Diagnosis and
Treatment. Cambridge UK: Cambridge University Press, 2003.

Competing interests:
None declared

Competing interests: No competing interests

24 December 2004
Max Fink
Professor or Psychiatry & Neurology Emeritus
SUNY at Stony Brook, NY 11794