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Catatonia, Neuroleptic Malignant Syndrome, and Serotonin Syndrome 

Catatonia, Neuroleptic Malignant Syndrome, and Serotonin Syndrome
Catatonia, Neuroleptic Malignant Syndrome, and Serotonin Syndrome

Pierre N. Azzam

and Priya Gopalan

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date: 18 September 2020

Catatonia, neuroleptic malignant syndrome (NMS), and serotonin syndrome share many common features, with nuanced distinctions in their pathophysiology and clinical presentation. Catatonia represents a psychomotor syndrome that is precipitated by various psychiatric and general medical conditions. Its purported pathophysiology—frontal-striatal depletion of dopamine and GABA—overlaps considerably with that of NMS. Clinical features of NMS (e.g., fever, rigidity, and confusion) so resemble severe cases of catatonia that NMS is believed to represent a drug-induced malignant catatonic variant. In comparison, serotonin syndrome also shares a number of clinical features, but represents a reaction specifically to pro-serotonergic agents. Nuances of the physical examination and history can help the clinician to correctly distinguish between these three conditions, so as to activate appropriate treatment and supportive care.

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