Initial management of neuroleptic malignant syndrome involves which action?

• A. Increase dose of antipsychotic medications
• B. Switch to a different neuroleptic without stabilization
• C. Immediate discontinuance of all antipsychotic medications and supportive care to treat dehydration and hyperthermia until stabilization
• D. Ignore and monitor

Answer: (C)

Neuroleptic malignant syndrome is a medical emergency caused by excessive dopamine receptor blockade from antipsychotics. The first and most important step is to stop the offending antipsychotic immediately to halt ongoing progression. Because patients can develop dehydration and dangerously high fever, immediate supportive care is started: aggressive IV hydration, cooling measures, electrolyte and hemodynamic monitoring, and careful monitoring of labs. This stabilization period is essential before considering further treatments. In many cases, additional therapies such as dantrolene or bromocriptine are used if symptoms persist or worsen. Increasing the dose or switching to another neuroleptic without stabilizing the patient would worsen the condition, and simply ignoring it is unsafe.