Neuroleptic malignant syndrome is manifested in severe muscle rigidity, fever, cognitive confusion, elevated creatinine phosphokinase and/or white blood count levels allegedly related to the administration of neuroleptic medications.4,32 A 1991 study found that cocaine abusers treated with neuroleptics developed NMS whereas nonabusers did not.33 Khaldarov34 successfully treated a patient, with a history of cocaine abuse and recent treatment with fluphenazine, with lorazepam on the basis of the assumption that cocaine-associated rhabdomyolysis with hyperthermia and NMS are the same condition.
Lopez-Canino and Francis,35 in their review of the literature on drug-induced catatonia from the study of phencyclidine intoxication by McCarron and colleagues,36 also noted an association between rhabdomyolysis and catatonia. Other studies have reported an association between psychosis (eg, mania and schizophrenia) involving overactivity, catatonia and rhabdomyolysis.37–39 In sum, the literature appears to suggest some association between the state of excited delirium, rhabdomyolysis, NMS and even catatonia. Studies have also noted that NMS and catatonia seem to be different aspects of the same syndrome (cf, Fink;40 Carroll;41 Koch and colleagues42). Petrides and colleagues43 propose that NMS itself is a form of catatonia whose features are similar to those of malignant catatonia and that they may both benefit from similar treatment.
The association researchers have established between excited delirium and the potentially life-threatening syndromes of rhabdomyolysis, NMS, and catatonia give impetus to the need for critical emergency medical interventions when encountering a person thought to be in a state of excited delirium.
