The most important intervention is to discontinue all antipsychotics. In most cases, symptoms will resolve in 1-2 weeks. Neuroleptic malignant syndrome precipitated by long-acting depot injections of antipsychotics can last as long as a month. During the course of neuroleptic malignant syndrome, use supportive care aggressively. The value of other interventions, such as dantrolene, amantadine, bromocriptine, and electroconvulsive therapy, is uncertain.
- Supportive measures are aimed at preventing further complications and maintaining organ function.
- Patients should receive circulatory and ventilatory support as needed.
- Cooling blankets and antipyretics can be used to control temperature.
- Aggressive fluid resuscitation and alkalization of urine can help prevent acute renal failure and enhance excretion of muscle breakdown products.
- Electroconvulsive therapy has been proposed as a treatment based on its effectiveness in acute lethal catatonia. Some data suggest that electroconvulsive therapy is effective for neuroleptic malignant syndrome, but serious treatment-related complications have occurred (see Complications). Specifically, patients with neuroleptic malignant syndrome have developed cardiac arrest and ventricular fibrillation after electroconvulsive therapy.