Neuroleptic Malignant Syndrome after the Addition of Lithium to Risperidone Treatment: A Case Report and Review of the Literature

Abstract

Neuroleptic malignant syndrome (NMS) is a rare but life-threatening complication of antipsychotic therapy. The classic features of NMS include muscular rigidity, altered mental status, autonomic instability and hyperthermia. NMS is most often associated with conventional antipsychotic usage. It has also been reported with lithium and antidepressants especially when combined with antipsychotics. Herein, we report a case involving a 35-year-old man with schizoaffective disorder in whom signs and symptoms consistent with NMS developed after lithium was added to his therapy of risperidone. A firm diagnosis of NMS was made on the basis of his history, physical, laboratory and neuroimaging findings. He was then followed up and treated in the intensive care unit with supportive care measures including aggressive cooling, intravenous fluid hydration, nutrition by nasogastric tube and therapy with bromocriptine. The patient had an uneventful clinical course and was discharged from the intensive care unit after three weeks with no complications related to the NMS.