A 32-year-old man with schizophrenia develops rigidity, hyperthermia (40.2°C), diaphoresis, and altered consciousness 2 days after his antipsychotic was switched to haloperidol at higher doses. Creatine kinase is markedly elevated. What is the FIRST-line pharmacological treatment?

• A Bromocriptine ✓
• B Dantrolene sodium
• C Lorazepam
• D Cooling blankets alone

Explanation

Neuroleptic Malignant Syndrome (NMS) is a life-threatening reaction to antipsychotics characterized by hyperthermia, lead-pipe rigidity, autonomic instability, and altered consciousness, along with elevated CK. The immediate step is to discontinue the offending antipsychotic and provide supportive care. Pharmacologically, bromocriptine (a dopamine agonist) is the first-line agent to reverse dopamine blockade. Dantrolene (a muscle relaxant reducing calcium-mediated contraction) is used as an adjunct or second-line agent. Lorazepam may help with agitation but does not address the underlying mechanism.

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

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