Neuroleptic Malignant Syndrome
An idiosyncratic, potenitally fatal cmplication of treatment with antipsychotics.

Pneumonic: FARM
F – fever
A – autonomic dysfunction
R – rigidity
M – mental status changes
( may progress to rhabdomyolyis +/- ARF)

Culprit Drugs:

• antipsychotics (typical > atypicals)
• dopamine antagonists (metoclopramide, proclorperazine)
• withdrawal of dopaminergics
• muscle relaxants

Clinical Course:

• most cases develop within 30 days of initiating therapies
• progression is insidious over days
• mental status changes usually precede systemic signs
• resolves 7-10 days after discontinuation of culprit drug
  

Treatment:

• discontinue culprit medication
• supportive care (fluids, cooling)
• watch for rhabdomyolyis and consider bicarb drip
• possible medications to consider – benzodiazepines, dopaminergic agents, dantrolene
• caution in restarting antipsychotics once resolved
• get some help from psyc!

for more details se review article....

http://ajp.psychiatryonline.org/cgi/reprint/164/6/870
Am J Psychiatry 164:6, June 2007