What are warning signs of neuroleptic malignant syndrome in patients on antipsychotics?

• A. Sudden fever, muscle rigidity, autonomic instability, and altered mental status; stop antipsychotics and provide supportive care, including cooling as needed.
• B. Gradual weight gain and mild fatigue over weeks.
• C. Mild tremor with normal autonomic signs.
• D. Only hypertension without other symptoms.

Answer: (C)

Neuroleptic malignant syndrome is a medical emergency caused by abrupt dopamine blockade from antipsychotics. The warning signs are the rapid onset of high fever, severe muscle rigidity, autonomic instability (such as fluctuating blood pressure and heart rate, sweating), and changes in mental status ranging from agitation to delirium. When these signs appear, stop the antipsychotic immediately and provide aggressive supportive care—cooling measures, aggressive hydration, close monitoring, and labs to track organ function. In contrast, patterns like gradual weight gain with fatigue, mild tremor without autonomic changes, or hypertension alone do not fit this acute, life-threatening syndrome.