A patient develops hyperthermia (40.5°C), generalised lead-pipe rigidity, autonomic instability, and elevated serum creatine kinase after starting a depot antipsychotic. The treatment of choice includes:

• A Lorazepam IV and antipyretics only
• B Immediate antipsychotic dose escalation to overcome dopamine receptor desensitisation
• C Physostigmine IV to reverse cholinergic blockade
• D Discontinue antipsychotic, dantrolene sodium, bromocriptine, and supportive care ✓

Explanation

This is Neuroleptic Malignant Syndrome (NMS), a life-threatening idiosyncratic reaction to dopamine-blocking agents. The cornerstone of management is immediate discontinuation of the offending drug, cooling measures, and pharmacotherapy with dantrolene (to reduce muscle rigidity and hyperthermia via ryanodine receptor blockade) and/or bromocriptine (dopamine agonist to restore central dopaminergic activity). Mortality from rhabdomyolysis and renal failure can exceed 10% if untreated.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.