{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T15:43:59Z","timestamp":1793375039436,"version":"4.5.0"},"reference-count":40,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T00:00:00Z","timestamp":1771027200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Neuroleptic malignant syndrome (NMS) is a rare but high-mortality clinical condition. The aim of this study was to describe the demographic characteristics, clinical and laboratory findings, management strategies, and clinical outcomes of adult patients with NMS treated in an adult intensive care unit. Materials and Methods: This retrospective descriptive study included adult patients admitted to a tertiary care ICU with a diagnosis of NMS. Data were obtained from medical records and included demographic characteristics, suspected NMS-related drug exposures, clinical and laboratory findings at ICU admission, disease severity indicators, treatments administered, and clinical outcomes. Continuous variables were expressed as median and interquartile range (IQR), and categorical variables as number and percentage. Results: A total of 42 patients were included. The median age was 48 years (IQR: 24.1\u201375.5), and 61.9% were male. Atypical antipsychotics were the most frequently implicated agents (69.0%). Altered mental status was observed in 92.9% of patients, tachycardia in 61.9%, and hyperthermia in 47.6%. Creatine kinase levels &gt;1000 U\/L were present in 57.1%, and leukocytosis in 71.4%. Mechanical ventilation was required in 59.5% of patients. Acute kidney injury developed in 31%, and continuous renal replacement therapy (CRRT) was initiated in 21.4%. Bromocriptine was administered in 54.8% of cases, dantrolene in 4.8%, and amantadine in 11.9%. The ICU mortality rate was 9.5%. Conclusions: Patients with neuroleptic malignant syndrome often present with a severe clinical course requiring advanced organ support in the intensive care unit. However, with early diagnosis and appropriate intensive care management, mortality can be maintained at acceptable levels.<\/jats:p>","DOI":"10.3390\/medicina62020378","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T12:37:28Z","timestamp":1771245448000},"page":"378","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Intensive Care Management and Outcomes of Neuroleptic Malignant Syndrome: A Single-Center Retrospective Study"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4197-5819","authenticated-orcid":false,"given":"Fatma","family":"\u00d6zdemir","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Bak\u0131rk\u00f6y Dr. Sadi Konuk Training and Research Hospital, Istanbul 34147, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9899-0545","authenticated-orcid":false,"given":"Dicle","family":"Birtane","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Bak\u0131rk\u00f6y Dr. Sadi Konuk Training and Research Hospital, Istanbul 34147, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4741-7877","authenticated-orcid":false,"given":"Nurdan","family":"Y\u0131lmaz","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Medipol Mega University Hospital, Istanbul 34214, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8893-3977","authenticated-orcid":false,"given":"Zafer","family":"\u00c7ukurova","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Bak\u0131rk\u00f6y Dr. Sadi Konuk Training and Research Hospital, Istanbul 34147, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"427","DOI":"10.4088\/JCP.10m06791","article-title":"Mortality of neuroleptic malignant syndrome induced by typical and atypical antipsychotic drugs: A propensity-matched analysis from the Japanese Diagnosis Procedure Combination database","volume":"73","author":"Nakamura","year":"2012","journal-title":"J. Clin. Psychiatry"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1001\/archpsyc.1989.01810100056011","article-title":"Risk factors for neuroleptic malignant syndrome: A case-control study","volume":"46","author":"Keck","year":"1989","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1007\/s12028-024-02192-y","article-title":"Contemporary perspectives in critical care of neuroleptic malignant syndrome","volume":"42","author":"Lopez","year":"2025","journal-title":"Neurocrit. Care"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/S0025-7125(16)30278-4","article-title":"Neuroleptic malignant syndrome","volume":"77","author":"Caroff","year":"1993","journal-title":"Med. Clin. N. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1176\/appi.psy.50.1.8","article-title":"Neuroleptic malignant syndrome complicating antipsychotic treatment of delirium or agitation in medical and surgical patients: Case reports and a review of the literature","volume":"50","author":"Seitz","year":"2009","journal-title":"Psychosomatics"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1002\/hup.483","article-title":"Olanzapine-induced neuroleptic malignant syndrome: A case review","volume":"18","author":"Kogoj","year":"2003","journal-title":"Hum. Psychopharmacol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1097\/WNF.0000000000000575","article-title":"Neuroleptic malignant syndrome in the context of lithium toxicity and aripiprazole use","volume":"47","author":"Schultz","year":"2024","journal-title":"Clin. Neuropharmacol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"160.e1","DOI":"10.1016\/j.ajem.2024.03.032","article-title":"Prochlorperazine-induced neuroleptic malignant syndrome","volume":"81","author":"Tee","year":"2024","journal-title":"Am. J. Emerg. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e228214","DOI":"10.1136\/bcr-2018-227216","article-title":"Neuroleptic malignant syndrome as part of an akinetic crisis associated with sepsis in a patient with Lewy body disease","volume":"12","author":"Manabe","year":"2019","journal-title":"BMJ Case Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"24","DOI":"10.18773\/austprescr.2019.006","article-title":"The hot patient: Acute drug-induced hyperthermia","volume":"42","author":"Jamshidi","year":"2019","journal-title":"Aust. Prescr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.4088\/JCP.10m06438","article-title":"An international consensus study of neuroleptic malignant syndrome diagnostic criteria using the Delphi method","volume":"72","author":"Gurrera","year":"2011","journal-title":"J. Clin. Psychiatry"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Publishing. [5th ed.].","DOI":"10.1176\/appi.books.9780890425787"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1097\/00005053-199403000-00007","article-title":"Progression of symptoms in neuroleptic malignant syndrome","volume":"182","author":"Velamoor","year":"1994","journal-title":"J. Nerv. Ment. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1176\/ajp.142.10.1137","article-title":"Neuroleptic malignant syndrome","volume":"142","author":"Levenson","year":"1985","journal-title":"Am. J. Psychiatry"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1176\/ajp.146.6.717","article-title":"A prospective analysis of 24 episodes of neuroleptic malignant syndrome","volume":"146","author":"Rosebush","year":"1989","journal-title":"Am. J. Psychiatry"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1080\/026990599121034","article-title":"Neuroleptic malignant syndrome induced by haloperidol following traumatic brain injury","volume":"13","author":"Wilkinson","year":"1999","journal-title":"Brain Inj."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Szota, A.M., Radajewska, I., Grudzka, P., and Araszkiewicz, A. (2020). Lamotrigine-, quetiapine- and aripiprazole-induced neuroleptic malignant syndrome in a patient with lithium-related renal failure. BMC Psychiatry, 20.","DOI":"10.1186\/s12888-020-02597-x"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Caroff, S.N., Roberts, C.B., Rosenberg, H., Tobin, J.R., Watt, S., Mashman, D., Riazi, S., and Berkowitz, R.M. (2022). Intravenous dantrolene in hypermetabolic syndromes: A survey of the U.S. Veterans Health Administration database. BMC Anesthesiol., 22.","DOI":"10.1186\/s12871-022-01841-z"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1080\/j.1440-1614.1999.00630.x","article-title":"Electroconvulsive treatment of neuroleptic malignant syndrome: A review and report of cases","volume":"33","author":"Trollor","year":"1999","journal-title":"Aust. N. Z. J. Psychiatry"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1002\/mds.1133","article-title":"Treatment of neuroleptic malignant syndrome with subcutaneous apomorphine monotherapy","volume":"16","author":"Wang","year":"2001","journal-title":"Mov. Disord."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"439","DOI":"10.20344\/amp.13019","article-title":"Diagnosis and treatment of neuroleptic malignant syndrome in the intensive care unit","volume":"34","author":"Maia","year":"2021","journal-title":"Acta Med. Port."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"S157","DOI":"10.1086\/317521","article-title":"Role of the preoptic-anterior hypothalamus in thermoregulation and fever","volume":"31","author":"Boulant","year":"2000","journal-title":"Clin Infect Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1034\/j.1600-0447.2000.102003226.x","article-title":"Circulatory catecholamines and serotonin in neuroleptic malignant syndrome","volume":"102","author":"Spivak","year":"2000","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1002\/ajmg.b.10025","article-title":"Dopamine D2 and D3 receptor gene polymorphisms and neuroleptic malignant syndrome","volume":"117B","author":"Mihara","year":"2003","journal-title":"Am. J. Med. Genet. B"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1097\/00002826-200207000-00001","article-title":"Is neuroleptic malignant syndrome a neurogenic form of malignant hyperthermia?","volume":"25","author":"Gurrera","year":"2002","journal-title":"Clin. Neuropharmacol."},{"key":"ref_26","unstructured":"UpToDate (2025, December 26). Neuroleptic Malignant Syndrome. Available online: https:\/\/www.uptodate.com\/contents\/neuroleptic-malignant-syndrome."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"73","DOI":"10.2165\/00002018-199819010-00006","article-title":"Neuroleptic malignant syndrome: Recognition, prevention and management","volume":"19","author":"Velamoor","year":"1998","journal-title":"Drug Saf."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1111\/acps.13215","article-title":"Neuroleptic malignant syndrome: A systematic case series analysis","volume":"142","author":"Kuhlwilm","year":"2020","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1080\/15504263.2014.961882","article-title":"Gender differences in psychotic disorders with concurrent substance use","volume":"10","author":"Caton","year":"2014","journal-title":"J. Dual Diagn."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1056\/NEJMra2404606","article-title":"Neuroleptic malignant syndrome","volume":"391","author":"Wijdicks","year":"2024","journal-title":"N. Engl. J. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"354","DOI":"10.4266\/acc.004632","article-title":"Neuroleptic malignant syndrome requiring intensive care unit admission in patients with SARS-CoV-2 infection","volume":"40","author":"Costa","year":"2025","journal-title":"Acute Crit. Care"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1176\/ajp.2007.164.6.870","article-title":"Neuroleptic malignant syndrome","volume":"164","author":"Strawn","year":"2007","journal-title":"Am. J. Psychiatry"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s43045-020-00081-6","article-title":"Neuroleptic malignant syndrome: Clinical expression, complications, and atypical presentation","volume":"28","author":"Oneib","year":"2021","journal-title":"Middle East. Curr. Psychiatry"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1097\/00004714-200206000-00004","article-title":"High serum creatine kinase as a possible risk factor for neuroleptic malignant syndrome","volume":"22","author":"Hermesh","year":"2002","journal-title":"J. Clin. Psychopharmacol."},{"key":"ref_35","first-page":"e56306","article-title":"Neuroleptic malignant syndrome with exceptionally high creatine kinase and myoglobin levels","volume":"16","author":"Macedo","year":"2024","journal-title":"Cureus"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1007\/s12028-015-0162-5","article-title":"Neuroleptic malignant syndrome: Complications, outcomes, and mortality","volume":"24","author":"Modi","year":"2016","journal-title":"Neurocrit. Care"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1097\/01.md.0000188565.48918.41","article-title":"Rhabdomyolysis: An evaluation of 475 hospitalized patients","volume":"84","author":"Melli","year":"2005","journal-title":"Medicine"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1080\/08860220500461252","article-title":"Successful treatment of six patients with Neuroleptic malignant syndrome associated with myoglobulinemic acute renal failure","volume":"28","author":"Sanai","year":"2006","journal-title":"Ren. Fail."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/S1353-8020(02)00122-0","article-title":"A collaborative study on the Malignant syndrome in Parkinson\u2019s disease and related disorders","volume":"9","author":"Takubo","year":"2003","journal-title":"Park. Relat. Disord."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/S1353-8020(02)00125-6","article-title":"Malignant syndrome in Parkinson\u2019s disease: Concept and review of the literature","volume":"9","author":"Mizuno","year":"2003","journal-title":"Park. Relat. Disord."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/2\/378\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T13:07:50Z","timestamp":1771247270000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/2\/378"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,14]]},"references-count":40,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["medicina62020378"],"URL":"https:\/\/doi.org\/10.3390\/medicina62020378","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,14]]}}}