J Psychiatr Pract. 2020 Jul;26(4):320-323. doi: 10.1097/PRA.0000000000000478.
Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal syndrome classically encountered in patients receiving typical antipsychotic agents. However, many physicians have also reported the occurrence of NMS with atypical antipsychotics, notably with atypical presentations. In this report, we present a case in which a patient's antipsychotic regimen during a psychotic episode (which involved both typical and atypical antipsychotics) subsequently led to NMS. During his stay, the patient developed an altered level of consciousness, elevation of creatine phosphokinase, hemodynamic instability, and a fever. However, the patient did not have signs of rigidity, the cardinal sign of this syndrome. The authors concluded that patients could develop NMS without rigidity while receiving an antipsychotic. Given this presentation, the authors suggest that clinicians have a high level of suspicion for NMS to avoid misdiagnosis and subsequent adverse consequences. Hence, clinicians must be vigilant about atypical presentations of NMS without rigidity.
神经阻滞剂恶性综合征（NMS）是一种罕见但潜在致命的综合征，在接受典型抗精神病药物治疗的患者中常可遇到。然而，许多医生也报告了非典型抗精神病药物引起的 NMS，特别是出现非典型表现。在本报告中，我们介绍了 1 例精神病发作期间（包括典型和非典型抗精神病药物）抗精神病药物治疗方案后发生 NMS 的病例。住院期间，患者出现意识改变、肌酸磷酸激酶升高、血流动力学不稳定和发热。然而，患者没有该综合征的主要特征——僵硬的迹象。作者得出结论，患者在接受抗精神病药物治疗时可能会出现无僵硬的 NMS。鉴于这种表现，作者建议临床医生高度怀疑 NMS，以避免误诊和随后的不良后果。因此，临床医生必须警惕无僵硬的 NMS 的非典型表现。
