Perry Paul J, Wilborn Courtney A
College of Pharmacy, Touro University-California, Vallejo, CA 94592, USA.
Ann Clin Psychiatry. 2012 May;24(2):155-62.
Serotonin syndrome (SS) and neuroleptic malignant syndrome (NMS) are uncommon but potentially life-threatening adverse reactions associated with psychotropic medications. Polypharmacy and the similar presentation of SS and NMS make diagnosis of the 2 syndromes problematic.
A MEDLINE search was performed for the period 1960 to 2011 for case reports, review articles, and studies pertaining to SS and NMS.
The majority of available literature on SS and NMS consists of case reports, case-control studies, and retrospective reviews. In addition, diagnostic criteria have been developed to aid in the diagnosis and management of SS and NMS.
SS presents as mental status changes, autonomic nervous system disturbances, neurologic manifestations, and hyperthermia. Similarly, NMS presents as muscle rigidity, hyperpyrexia, mental status changes, and autonomic instability. However, the clinical laboratory profile of elevations in creatine kinase, liver function tests (lactate dehydrogenase, aspartate transaminase), and white blood cell count, coupled with a low serum iron level, distinguishes NMS from SS among patients taking neuroleptic and serotonin agonist medications simultaneously. For both SS and NMS, immediate discontinuation of the causative agent is the primary treatment, along with supportive care. For NMS, dantrolene is the most effective evidence-based drug treatment whereas there are no evidence-based drug treatments for SS. A 2-week washout of neuroleptic medication minimizes the chance of recurrence.
血清素综合征（SS）和抗精神病药恶性综合征（NMS）并不常见，但与精神药物相关的潜在危及生命的不良反应。联合用药以及SS和NMS的相似表现使得这两种综合征的诊断存在问题。
对1960年至2011年期间的MEDLINE进行检索，查找与SS和NMS相关的病例报告、综述文章及研究。
关于SS和NMS的现有文献大多由病例报告、病例对照研究和回顾性综述组成。此外，已制定诊断标准以协助SS和NMS的诊断与管理。
SS表现为精神状态改变、自主神经系统紊乱、神经学表现和体温过高。同样，NMS表现为肌肉强直、高热、精神状态改变和自主神经不稳定。然而，在同时服用抗精神病药和血清素激动剂药物的患者中，肌酸激酶、肝功能检查（乳酸脱氢酶、天冬氨酸转氨酶）及白细胞计数升高，同时血清铁水平降低的临床实验室特征可将NMS与SS区分开来。对于SS和NMS，首要治疗措施均为立即停用致病药物，并给予支持性护理。对于NMS，丹曲林是最有效的循证药物治疗，而对于SS则没有循证药物治疗。停用抗精神病药2周可将复发几率降至最低。
