Epidemiology
Etiology
- High-potency first-generation antipsychotics (most common association)
- Second-generation antipsychotics
- Other dopamine antagonists, e.g., metoclopramide, promethazine
Pathophysiology
- Central D2 receptor blockade in the nigrostriatal pathway and hypothalamus, resulting in movement disorders and impaired thermoregulation
Clinical features
- Mental status changes (encephalopathy)
- Delirium (e.g., reduced vigilance)
- Confusion
- Stupor
- Catatonia
- Parkinsonism
- Hyperthermia: High-grade fever is common.
- Autonomic instability
- Tachycardia, dysrhythmias, labile blood pressure
- Tachypnea
- Diaphoresis
Diagnostics
Clinical features similar to Serotonin syndrome