mrcpsych-1900

mrcpsych-1900

A 24-year-old male patient with a history of hallucinations and delusions was started on multiple medications by a psychiatrist. However, on the second day of treatment, he developed excessive sweating, fever, agitation, and aggressive behavior. The psychiatrist continued with the medications, which were eventually stopped after 4 days. Over the next few days, the patient’s condition worsened, and he developed diarrhea and sustained high-grade fever. He was transferred to a hospital, where he was found to have hypertonia in all four limbs, mainly in the lower extremities, and hyper-reflexia, including bilateral sustained ankle clonus.

These signs and symptoms are most helpful in distinguishing between serotonin syndrome and neuroleptic malignant syndrome.