Risk factors in neuroleptic malignant syndrome. A case–control study


Luis-Fernando Viejo MD, Department of Internal Medicine, Provincial Hospital of Toledo, County Council of Toledo, Cerro de San Servando s/n, 45006 Toledo, Spain
E-mail: lferviejoll@navegalia.com


Objective: To determine whether environmental temperature, agitation, neuroleptic use, mental retardation, and affective disorders were risk factors for neuroleptic malignant syndrome (NMS).

Method: Cases and age- and sex-matched psychiatric controls admitted to a regional acute psychiatric unit over a 10-year period.

Results: Both uni- and multivariate analysis revealed statistically significant differences between patients with NMS (n=15) and controls (n=45) with regard to the presence of mental retardation, psychomotor agitation, and a number of variables relating to neuroleptic use (newly introduced or increased, intramuscular administration, and dosage). We found no differences between NMS patients and psychiatric controls in respect of changes in environmental temperature.

Conclusion: Our study supports the need for caution when using intramuscularly administered, abruptly increasing, high-dose neuroleptics, particularly in mentally retarded or agitated patients, regardless of environmental temperature.