CATATONIA AND MALIGNANT SYNDROME - POSSIBLE COMPLICATION OF NEUROLEPTIC ADMINISTRATION

An unusual, acute extrapyramidal reaction, which resulted from treatment with haloperidol and which was unresponsive to standard anticholinergic treatment and indistinguishable on clinical grounds from acute catatonia, is described. Because the etiology of this reaction was not appreciated, progressive, life-threatening physiological deterioration ensued accompanied by unremitting neuromuscular symptoms, a clinical picture resembling both lethal catatonia and the rare neuroleptic malignant syndrome. The literature on these conditions is reviewed, and various problems in differential diagnosis are discussed. Some cases of the neuroleptic malignant syndrom and perhaps lethal catatonia may represent evolution of severe extrapyramidal reactions.