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Acute Dystonic Reaction and the Neuroleptic Malignant Syndrome

Departments of Emergency Medicine and Pediatrics, Wayne State University School of Medicine, Children’s Hospital of Michigan Regional Poison Control Center, Detroit, Michigan, swhite1{at}dmc.org

Up to 90% of patients on chronic antipsychotic therapy will experience adverse neurologic side effects, with many of these effects attributable to the dopamine-blocking properties of these drugs. Even the newer, "atypical" antipsychotics are increasingly associated with neurologic complications. In the acute care setting, these medications have broad application beyond the management of psychiatric illness. Given the extent of their use, clinicians should be familiar with the spectrum of neurological syndromes that can develop. Some are common, such as akathisia, acute dystonic reaction, tardive dyskinesia, and drug-induced parkinsonism. Others, such as the life-threatening neuroleptic malignant syndrome, are rare yet must be recognized early to affect survival and improve outcome. This discussion highlights 2 idiosyncratic syndromes, acute dystonic reaction and neuroleptic malignant syndrome. The differential diagnosis for both syndromes and their management is discussed.

Key Words: Neuroleptic malignant syndrome • acute dystonic reaction • dopamine • hyperthermia • rigidity

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