Prognosis

Some cases of NMS are milder than those in published reports, which may reflect a greater awareness of the risk for this syndrome and more prompt intervention. However, it is possible that NMS manifests in a spectrum of clinical severity.

Mortality associated with NMS appears to vary.[8][12][14][15]​​[16][17][18]​ Two large studies reported a rate between 8% and 9%.[10][19]

Recurrence of NMS has been estimated to be as high as 30%, but there are no reliable data regarding recurrence.[12] 

Seek advice from the patient’s mental health team before restarting antipsychotic medication.

  • If possible, delay restarting antipsychotic medication for at least 2 weeks following complete resolution of the NMS episode to reduce the risk of recurrence.

  • If feasible, avoid the antipsychotic that caused NMS, and depot preparations. Some experts recommend a second-generation antipsychotic, with lower risk of extrapyramidal adverse effects, in preference to first-generation antipsychotic medications.

  • Always start the antipsychotic at a low dose and slowly titrate while monitoring the patient closely to assess for signs of recurrence.[24][67][68]

Use of this content is subject to our disclaimer