According to the Hunter criteria, in a patient with documented exposure to a serotonergic agent, which finding is required along with fever for a positive diagnosis of serotonin syndrome?
- A Lead-pipe rigidity
- B Diarrhoea alone
- C Spontaneous or inducible clonus ✓
- D Hyporeflexia
Correct answer: C. Spontaneous or inducible clonus
Explanation
The Hunter criteria require serotonergic exposure plus spontaneous, inducible, or ocular clonus, or tremor with hyperreflexia, or hypertonia with temperature above 38 degrees and ocular clonus or inducible clonus. Clonus and hyperreflexia are central to the diagnosis. Lead-pipe rigidity and hyporeflexia point toward NMS rather than serotonin syndrome.
Reference: Kaplan and Sadock's Synopsis of Psychiatry, 12th ed.
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