<prompt> Neurolept Malignant Syndrome NMS is caused by?MetoclopramidePhenothiazinesHaloperidolAll of the above  <response>: Ans. D. All of the above. Ref H - 17thpg. 118; Table 17-1Harrisons internal medicine - 17thpg, 118...The neuroleptic malignant syndrome NMS occurs in the setting of neuroleptic agent use antipsychotic phenothiazines, haloperidol, prochlorperazine, metoclopramide or the withdrawal of dopaminergic drugs and is characterized by lead-pipe muscle rigidity, extrapyramidal side effects, autonomic dysregulation, and hyperthermia.NMS is rare dose-related adverse effect of neuroleptics characterized by marked rigidity, immobility, tremors, hyperpyrexia, fluctuating BP and HR, semiconsciousness and myoglobin in blood. It should generally be treated with dantrolene and dopamine agonists.Drugs that may cause neuroleptic malignant syndrome : Phenothiazines; Butyrophenones, including haloperidol and bromperidol; Fluoxetine; Loxapine; Tricyclic and benzodiazepines; Metoclopramide Domperidone; Thiothixene; Molindone; Withdrawal of dopaminergic agentsNeuroleptic medications associated with neurolaptic malignant syndromeTypical neurolepticsA Atypical neurolepticHaloperidol Clozapine Chlorpromazine Clanzapine Fuphenazine, long acting Quetia pine Fluphonazine pospendone Lavoropromazine Loxapine rarely associated with NMS, more commonly asociated with NMS Clinical differencesNMSSerotonin syndromePrecipitating factorsSudden withdrawal of dopaminergic agents or introduction agents that block dopamine signaling e.g., neuroleptics and antiometicsCombination of agents that potentially stimulate serotonia receptors such as SSRIs and MAOIsOnsetSlower; 3-9 days following and addition of neurolepticsSudden within 24 hrs in 75 of cases following the addiltion of a serotonergic agentMental statusStupor, alert mutism, comaAgitation, comaAutonomic symptomsHyperthermia 38ICDilated pupils, diarrhea, diaphoresis, vomitingNeuromuscular symptoms and signsAkinesia, extrapyramidal rigidityShivering, ataxia, myoclonus, hyperreflexia, ankle clonus, Barbilnski sign, systagmusElevation of WBC, LFT and muscle enzymesCommonLess frequentlyRecoverySlower, days to weeksRapid, 70 within 24 hrsMortality15-202.5 