Table 1 Symptoms of NMS and treatment

1.Symptoms of NMS

sudden agitation, delusional beliefs; consciousness disturbances;

fever over 39 °C.;

‘cogwheel ‘muscle rigidity;

tremor and sopor;

vital signs as follows; blood pressure 80/50 mmHg and heart rate 100 beats/minute.

2. Laboratory results

CRP 334,90 mg/dl, LDH 357 U/l,

CPK 6988 U/I,

GFR 20 ml/min, creatinine 2.55 mg/dl.

3. NMS treatment

a. All antipsychotic drugs (aripiprazole and quetiapine) and lamotrigine were withdrawn.

b. Amantadine (up to 200 mg/d), lorazepam (3 mg/d) and bromocriptine (3.75 mg/d) were initiated.

c. The patient’s condition improved after 5 days of the treatment.

4.Further treatment of the patient

a. Because of severe psychotic symptoms clozapine and lamotrigine were commenced very slowly. Clozapine has a low risk of causing NMS and was titrated from 12.5 mg/per week to a dose of 200 mg/d, whereas lamotrigine was titrated from 25 mg/d every two weeks to a dose of 225 mg/d.

b. After 4 months of treatment, clinical improvement was observed and the patient was discharged from hospital in a good general condition.