Neuroleptic Malignant Syndrome/Malignant Catatonia in Child Psychiatry: Literature Review and a Case Series

J Child Adolesc Psychopharmacol. 2017 May;27(4):359-365. doi: 10.1089/cap.2016.0180. Epub 2017 Feb 23.


Objective: To describe the presentation of neuroleptic malignant syndrome (NMS) and malignant catatonia (MC) in children and adolescents.

Background: NMS and MC are life-threatening, neuropsychiatric syndromes, associated with considerable morbidity and mortality. NMS is diagnosed when there is a recent history of treatment with an antipsychotic (AP) medication, while MC is diagnosed when the symptoms resemble NMS but without a history of exposure to an AP agent. Some authorities believe that apart from the history of exposure to an AP medication, the two conditions are identical. The symptoms of NMS/MC include severe agitation, behavior disregulation, motor and speech changes, self-injury and aggression, autonomic instability, and a range of psychiatric symptoms (affective, anxiety, or psychotic symptoms). Patients may be misdiagnosed with another disorder leading to extensive tests and a delay in treatment. Untreated, the condition may be fatal in 10%-20% of patients, with death sometimes occurring within days of disease onset.

Method: We describe the presentation and management of five children and adolescents with NMS/MC.

Conclusion: MC and NMS are life-threatening medical emergencies, which if diagnosed promptly, can be successfully treated with known effective treatments (benzodiazepines and/or electroconvulsive therapy).

Keywords: adolescents; children; malignant catatonia (MC); neuroleptic malignant syndrome (NMS).

Publication types

  • Review

MeSH terms

  • Antipsychotic Agents / therapeutic use*
  • Benzodiazepines / therapeutic use
  • Catatonia / diagnosis*
  • Child
  • Child Psychiatry
  • Electroconvulsive Therapy / methods
  • Humans
  • Neuroleptic Malignant Syndrome / diagnosis*
  • Neuroleptic Malignant Syndrome / drug therapy*
  • Self-Injurious Behavior


  • Antipsychotic Agents
  • Benzodiazepines