To the Editor.—
While we agree with Levinson and Simpson1 that reported cases of neuroleptic malignant syndrome (NMS) are heterogeneous and that extrapyramidal symptoms (EPS) and medical disorders ought to be treated, several points require clarification.The authors reevaluated data on 67 patients drawn from over 300 case reports of NMS published since 1960. They suggested that NMS, as conceptualized by most investigators, is neither "unitary" nor malignant. However, this conclusion may be unwarranted in view of inconsistencies and ambiguities in their analysis. For example, concurrent treatment with lithium carbonate was used initially to eliminate two cases from analysis, while six of 14 "not ill" patients were also receiving lithium carbonate. Similarly, dehydration, which is unlikely to be neglected as a cause of fever by experienced clinicians, was used both to exclude cases and, as a relevant medical factor, to classify cases. In addition, the criteria used to define the
Caroff SN, Mann SC, Lazarus A. Neuroleptic Malignant Syndrome. Arch Gen Psychiatry. 1987;44(9):838–839. doi:10.1001/archpsyc.1987.01800210090015
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