Diagnosis information

Neuroleptic malignant syndrome (NMS)

Core diagnostic criteria, specifiers, differential considerations, and documentation support in one open, scan-friendly view.

G21.0Medication-Induced MovementLocal clinical reference

Criteria: 3 criteria, A–C
Specifiers: 4 specifiers
Differentials: 6 considerations
Severity specifier: Supported

Core diagnostic criteria

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A
Core criterion A
Dopamine antagonist exposure (antipsychotic or antiemetic) and development of severe muscle rigidity and elevated temperature
B
Core criterion B
≥2 of: diaphoresis; dysphagia; tremor; incontinence; change in level of consciousness (confusion to coma); mutism; tachycardia; elevated/labile BP; leukocytosis; elevated CK
C
Core criterion C
Not attributable to another substance or medical/neurological condition

Specifiers

Associated with antipsychotic exposure: Onset linked to recent initiation, dose escalation, or parenteral use of dopamine-blocking agents.
Associated with dopaminergic withdrawal: Onset following abrupt cessation or reduction of dopaminergic medication.
With severe rhabdomyolysis: Marked muscle breakdown with significant CK elevation and renal risk.
Severity (Mild / Moderate / Severe): Graded by intensity of rigidity, degree of hyperthermia, autonomic instability, and level of consciousness.

Documentation support

Consistent with [Neuroleptic Malignant Syndrome] [specifier(s)]. Following recent exposure to a dopamine-blocking agent or abrupt withdrawal of dopaminergic medication, there has been the acute development of severe muscular rigidity; hyperthermia; altered mental state; autonomic instability including tachycardia; labile blood pressure; diaphoresis; tachypnoea, forming a rapidly evolving, life-threatening syndrome with onset over hours to days. The presentation is further characterised by marked creatine kinase elevation; leukocytosis; myoglobinuria; acute kidney injury; metabolic acidosis, reflecting systemic toxicity and muscle breakdown. These features have resulted in severe, clinically significant impairment requiring urgent medical intervention, and the disturbance does not occur exclusively during delirium. The pattern is best explained by neuroleptic malignant syndrome and is not better accounted for by serotonin syndrome, malignant hyperthermia, heat stroke, central nervous system infection, withdrawal states, or a primary neurological disorder.

Adapt this supplied template to the assessment. It is not a substitute for diagnostic reasoning or local documentation requirements.

DSM-5 DiagnosisDSM-mim-neuroleptic-malignant-syndrome-nmsSupplied local catalogue