{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T20:10:02Z","timestamp":1756325402708,"version":"3.44.0"},"reference-count":13,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,1,19]]},"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:p>An incarcerated male patient with a psychiatric history of schizoaffective disorder presented to the emergency department with muscle rigidity and mutism after receiving a 150 mg haloperidol decanoate injection. At the peak of his illness, symptoms included muscular rigidity, mutism, excessive drooling, an altered level of consciousness, tachycardia, diaphoresis and tremors. Atypical neuroleptic malignant syndrome (NMS) was diagnosed after discrediting similar illnesses through clinical reasoning, laboratory and imaging studies. He was successfully treated during a 40-day hospitalisation with lorazepam, amantadine, methocarbamol and supportive care. This case represents an atypical presentation of NMS due to the patient\u2019s lack of fever development. Nonetheless, he satisfied many other criteria, most notably rapid symptom onset after receiving a first-generation antipsychotic medication. The case also provides an opportunity to discuss the prevalence of psychiatric illness among the US incarcerated population and incarceration as a risk factor for developing NMS.<\/jats:p>","DOI":"10.1136\/bcr-2023-257563","type":"journal-article","created":{"date-parts":[[2024,2,6]],"date-time":"2024-02-06T12:55:27Z","timestamp":1707224127000},"page":"e257563","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Atypical neuroleptic malignant syndrome in an incarcerated patient: a demographic who may be at increased risk"],"prefix":"10.1136","volume":"17","author":[{"given":"Matthew","family":"Zabel","sequence":"first","affiliation":[{"name":"College of Osteopathic Medicine, Rocky Vista University College of Osteopathic Medicine, Parker, Colorado, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajeev","family":"Kandukuri","sequence":"additional","affiliation":[{"name":"Psychiatry, Parkview Medical Center, Pueblo, Colorado, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,2,6]]},"reference":[{"key":"2025082712374470000_17.2.e257563.1","unstructured":"Simon LV , Hashmi MF , Callahan AL . Neuroleptic malignant syndrome. In: In: StatPearls [Internet]. Treasure Island. FL: StatPearls Publishing, 2023."},{"key":"2025082712374470000_17.2.e257563.2","doi-asserted-by":"publisher","DOI":"10.2174\/1570159X13999150424113345"},{"key":"2025082712374470000_17.2.e257563.3","doi-asserted-by":"publisher","DOI":"10.1007\/s40268-014-0078-0"},{"key":"2025082712374470000_17.2.e257563.4","first-page":"577","article-title":"Care of Incarcerated Patients","volume":"98","author":"Davis","year":"2018","journal-title":"Am Fam Physician"},{"key":"2025082712374470000_17.2.e257563.5","unstructured":"National Institute of Mental Health . Mental illness \u2013 prevalence of any mental illness - AMI [online]. 2023. Available: https:\/\/www.nimh.nih.gov\/health\/statistics\/mental-illness#part_2538 [Accessed 11 Jul 2023]."},{"key":"2025082712374470000_17.2.e257563.6","doi-asserted-by":"publisher","DOI":"10.1177\/1078345814532419"},{"key":"2025082712374470000_17.2.e257563.7","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1177\/02537176221099307","article-title":"Neuroleptic Malignant Syndrome with Low Dose Lithium, Without Concomitant Antipsychotics","volume":"45","author":"Ramadas","year":"2023","journal-title":"Indian J Psychol Med"},{"key":"2025082712374470000_17.2.e257563.8","doi-asserted-by":"crossref","unstructured":"Kuchibatla SS , Cheema SA , Chakravarthy KS , et al . A case report of neuroleptic malignant syndrome. BMJ Case Rep 2009;2009. doi:10.1136\/bcr.07.2008.0429","DOI":"10.1136\/bcr.07.2008.0429"},{"key":"2025082712374470000_17.2.e257563.9","doi-asserted-by":"crossref","unstructured":"Edinoff AN , Mohammad-Amin H , Odisho AS . Silent Neuroleptic Malignant Syndrome: A Case Report of Atypical Antipsychotic Induced Elevation of Creatinine Kinase and Altered Mental Status. Health Psychol Res 2022;10. doi:10.52965\/001c.37530","DOI":"10.52965\/001c.37530"},{"key":"2025082712374470000_17.2.e257563.10","doi-asserted-by":"crossref","first-page":"145","DOI":"10.5582\/ddt.2021.01012","article-title":"Neuroleptic malignant syndrome in a case of extra-pontine myelinolysis: On the horns of dilemma","volume":"16","author":"Arora","year":"2022","journal-title":"Drug Discov Ther"},{"key":"2025082712374470000_17.2.e257563.11","article-title":"Neuroleptic Malignant Syndrome From Oxcarbazepine and Topiramate Withdrawal: An Unusual Case","volume":"14","author":"Dang","year":"2022","journal-title":"Cureus"},{"key":"2025082712374470000_17.2.e257563.12","doi-asserted-by":"crossref","unstructured":"Durbach JR , Rosen G , De La Cuesta C , et al . Atypical Neuroleptic Malignant Syndrome in a COVID-19 Intensive Care Unit. Cureus August 2022. doi:10.7759\/cureus.27923","DOI":"10.7759\/cureus.27923"},{"key":"2025082712374470000_17.2.e257563.13","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2018-225840","article-title":"Neuroleptic malignant syndrome: a concealed diagnosis with multitreatment approach","volume":"12","author":"Velosa","year":"2019","journal-title":"BMJ Case Rep"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2023-257563","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T19:37:55Z","timestamp":1756323475000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2023-257563"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2]]},"references-count":13,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,2,6]]},"published-print":{"date-parts":[[2024,2]]}},"alternative-id":["10.1136\/bcr-2023-257563"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2023-257563","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2024,2]]}}}