Studies of risk factors and preventive care for neuroleptic malignant syndrome]

Neuroleptic malignant syndrome (NMS) is a life-threatening complication of anti-psychotic treatment and can occur any time during the course of treatment. Since NMS can occur in any subject treated with anti-psychotic drugs, causing senously adverse side effects, prevention of NMS is one of the most important issues in clinical psychiatry. Although therapeutic guidelines for NMS have been proposed and gradually put in place, the pathogenesis has not been fully elucidated. Prevention of NMS consists of three approaches: removal of pathogenetic factors, understanding of initial symptoms and consideration of the administration of preventive drugs. Risk factors for NMS are inherited factors, individual factors and environmental factors. The overlapping of these factors might lead to fulminant NMS. These risk factors such as environmental factors are enumerated in DSM-IV. We meta-analyzed the case-control studies of the risk factors for NMS, because the evaluation of each risk factor has not been studied yet. The results were as follows: mental retardation, psychiatric manifestations such as agitation and excitement as individual factors. High dosage administration, rapid increase and parenteral administration of antipsychotic drugs are the drug factors. It is hopeful to give preventive care, such as precautionary measurement of autonomic dysfunction, and treatment to these groups at high risk for NMS.