• Korean Journal of Biological Psychiatry
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• v.5 no.1
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• pp.138-141
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• 1998

Neuroleptic malignant syndrome (NMS) is an uncommon but potentially fatal idiosyncratic reaction to neuroleptics, characterized by muscular rigidity, fever, autonomic dysfunction, and altered consciousness. The major theories to explain NMS is central dopaminergic blockade, but it is unclear. Risperidone is a new antipsychotic drug, a benzisoxazole derivative that blocks dopamine $D_2$ receptor and serotonin type 2 receptor. The comparatively greater serotonin-blocking activity is believed to give risperidone the specific property of not causing any more extrapyramidal side effects than conventional antipsychotics at the optimal dose of 4-8mg/day. It is postulated that risperidone is unlikely to cause NMS. Here, we report a case of risperidone induced neuroleptic malignant syndrome.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.24 no.1
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• pp.13-20
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• 2013

Neuroleptic malignant syndrome (NMS) is a severe iatrogenic complication of treatment with antipsychotic medication. The aim of this review is to provide the clinical characteristics and treatments of children and adolescents with NMS. Searches were conducted in Medline, Korean studies Information Service System (KISS), and Research Information Service System (RISS). Sixteen case reports and two review articles were selected in Medline, and two Korean cases reported in department of emergency medicine and pediatrics were selected from RISS. Heterogeneous and atypical presentations of NMS were observed in children and adolescents. Some noticeable differences were observed between adult patients and child patients with NMS. In addition, symptom presentations related to atypical antipsychotic agents differed from those of typical ones. In treatment, bromocriptine and benzodiazepine were recommended for management of symptoms. In particular, electroconvulsive therapy (ECT) was a useful treatment option. For prevention and early detection of NMS in children and adolescents, evaluation of risk factors and understanding of diagnostic features of NMS are very important.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.9 no.2
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• pp.247-252
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• 1998

Neuroleptic malignant syndrome(NMS) is an acute, potentially fatal, idiosyncratic reaction to neuroleptic medication. Early recognition and intensive care are crucial. An important issue is whether NMS will recur after initial recovery and subsequent use of neuroleptic medication. The authors presented with a male adolescent who had suffered a bipolar disorder manic episode and been taking clozapine after recovering from MNS. He had been admitted into a psychiatric ward once before and similarly diagnosed. On the second admission, he showed muscle rigidity, autonomic instability, mild fever, severe diaphoresis, and altered mental status on the fourth hospital day following a haloperidol injection. He was diagnosed with NMS, according to the clinical signs and laboratory data. After the use of antipsychotics was discontinued, he was moved to intensive care unit and given dantrolene. His condition began to improve about 48 hours after the onset of NMS. Due to manic behavior, he returned to the psychiatric ward. On the 21 st hospital day, clozapine was administered to counter the manic symptoms. The final dose was 350mg and showed good remission signs without further recurrence of NMS.

• Korean Journal of Psychosomatic Medicine
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• v.30 no.2
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• pp.66-72
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• 2022

Clozapine is accepted as the "gold standard" antipsychotics for treatment-resistant schizophrenia. Clozapine rarely causes extrapyramidal syndrome and tardive dyskinesia, which are common with other antipsychotics, and only a transient elevation of hyperprolactinemia has been reported. Despite such clinical usefulness, there are limitations to the use of clozapine due to adverse drug reactions (ADR). Fever is a common in adverse drug reactions associated with clozapine. At initiation of clozapine most fatal ADR such as agranulocytosis and neuroleptic malignant syndrome associated with fever, in which case clozapine should be discontinued immediately. However, as benign causes of fever are much more frequent than life-threatening ADR, clozapine should not be discontinued unconditionally in the event of fever during clozapine initiation. In addition, fever may occur at any time during the maintenance of clozapine treatment. In particular, since the risk of pneumonia does not decrease over time, and clozapine has a higher risk of pneumonia than other antipsychotic drugs, it is recommended to adjust clozapine dosage through therapeutic drug monitoring.