Management
This is dependent on the severity of the condition.
If the full blown condition is present (fever, rigidity, autonomic instability, altered consciousness) then:
- treatment is with immediate cessation of neuroleptics, rehydration, and correction of fever and acidosis
- during an episode the use of electroconvulsive therapy and benzodiazepines are considered to be safe
- rechallenge with neuroleptics is probably safe if a gap of 2 weeks has been left between resolution of the neuroleptic syndrome and the reintroduction of the drug
- use of dantrolene and bromocriptine is unproven
In mild or early cases then management is more controversial:
- withdrawal of neuroleptics may delay resolution or worsen the psychosis, and withdrawing them from every patient with fever and rigidity would be questionable
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