A 32-year-old woman with schizophrenia develops severe hyperthermia (40.5°C), muscular rigidity, altered consciousness, and autonomic instability 4 days after starting haloperidol. Her CK is 4500 U/L and WBC is 15,000/µL. What is the most appropriate immediate pharmacological treatment?

• A Dantrolene IV and bromocriptine ✓
• B Lorazepam IV and bromocriptine
• C Cyproheptadine and cooling measures
• D Amantadine and diphenhydramine

Explanation

This is Neuroleptic Malignant Syndrome (NMS), characterized by hyperthermia, lead-pipe rigidity, autonomic instability, and altered consciousness with elevated CK. Immediate management includes stopping the antipsychotic, aggressive cooling, and pharmacotherapy with dantrolene (muscle relaxant that inhibits SR calcium release) and bromocriptine (dopamine agonist to restore D2 receptor blockade). Cyproheptadine (serotonin antagonist) is used in serotonin syndrome. Lorazepam is used for catatonia. NMS mortality is ~10% if untreated.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.