{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T16:46:29Z","timestamp":1776703589986,"version":"3.51.2"},"reference-count":11,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2014,6,6]]},"abstract":"<jats:p>Serotonin syndrome and neuroleptic malignant syndrome are two drug toxidromes that have often overlapping and confusing clinical pictures. We report a case of a young man who presented with alteration of mental status, autonomic instability and neuromuscular hyperexcitability following ingestion of multiple psychiatric and antiepileptic medications. The patient satisfied criteria for serotonin syndrome and neuroleptic malignant syndrome, and based on the characteristic clinical features, laboratory findings and clinical course it was concluded that the patient had both toxidromes. The patient was managed with cyproheptadine and supportive measures, and recovered over the course of 3\u2005weeks. A brief review of literature highlighting the diagnostic clues as well as the importance of recognising and distinguishing the often missed and confounding diagnoses follows.<\/jats:p>","DOI":"10.1136\/bcr-2014-204154","type":"journal-article","created":{"date-parts":[[2014,6,23]],"date-time":"2014-06-23T14:03:45Z","timestamp":1403532225000},"page":"bcr2014204154","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":35,"title":["Serotonin syndrome versus neuroleptic malignant syndrome: a challenging clinical quandary"],"prefix":"10.1136","volume":"2014","author":[{"given":"Rupal","family":"Dosi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annirudh","family":"Ambaliya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harshal","family":"Joshi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rushad","family":"Patell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2014,6,23]]},"reference":[{"key":"2025042705533386000_2014.jun23_2.bcr2014204154.1","first-page":"533","article-title":"Serotonin syndrome","volume":"13","author":"Volpi-Abadie","year":"2013","journal-title":"Ochsner J"},{"key":"2025042705533386000_2014.jun23_2.bcr2014204154.2","first-page":"310","article-title":"Overview of serotonin syndrome","volume":"24","author":"Iqbal","year":"2012","journal-title":"Ann Clin Psychiatry"},{"key":"2025042705533386000_2014.jun23_2.bcr2014204154.3","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.164.6.870"},{"key":"2025042705533386000_2014.jun23_2.bcr2014204154.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra041867"},{"key":"2025042705533386000_2014.jun23_2.bcr2014204154.5","doi-asserted-by":"publisher","DOI":"10.1080\/10401230600801259"},{"key":"2025042705533386000_2014.jun23_2.bcr2014204154.6","first-page":"155","article-title":"Serotonin syndrome vs neuroleptic malignant syndrome: a contrast of causes, diagnoses, and management","volume":"24","author":"Perry","year":"2012","journal-title":"Ann Clin Psychiatry"},{"key":"2025042705533386000_2014.jun23_2.bcr2014204154.7","doi-asserted-by":"crossref","first-page":"e20","DOI":"10.1097\/CCM.0b013e3182742d95","article-title":"Treatment of four psychiatric emergencies in the ICU","volume":"41","author":"Suarez-Contreras","year":"2013","journal-title":"Crit Care Med"},{"key":"2025042705533386000_2014.jun23_2.bcr2014204154.8","doi-asserted-by":"publisher","DOI":"10.2165\/00023210-200216100-00003"},{"key":"2025042705533386000_2014.jun23_2.bcr2014204154.9","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1002\/pds.1937","article-title":"Neuroleptic malignant syndrome and its controversies","volume":"19","author":"Margeti\u0107","year":"2010","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"2025042705533386000_2014.jun23_2.bcr2014204154.10","first-page":"69","article-title":"Serotonin syndrome or NMS? Clues to diagnosis","volume":"9","author":"Kimmel","year":"2010","journal-title":"Curr Psychiatry"},{"key":"2025042705533386000_2014.jun23_2.bcr2014204154.11","first-page":"1139","article-title":"Prevention, diagnosis, and management of serotonin syndrome","volume":"81","author":"Ables","year":"2010","journal-title":"Am Fam Physician"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2014-204154","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T12:53:46Z","timestamp":1745758426000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2014-204154"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,6,23]]},"references-count":11,"alternative-id":["10.1136\/bcr-2014-204154"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2014-204154","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,6,23]]}}}