Le cas clinique du mois. Syndrome malin des neuroleptiques et paralysie generale

Described in 1960 by Jean Delay in relation to the use of haloperidol, neuroleptic malignant syndrome remains relatively rare, and poorly known by the medical profession. The emergence of the atypical antipsychotic agents and preventive measures which have become general in recent years in hospital departments using dopamine receptor antagonists has not altered the prognosis, which remains potentially fatal in approximately a quarter of cases. This article proposes a descriptive summary of this syndrome in terms of clinical and biological diagnostics as well as of evolution, epidemiology, differential diagnosis and treatment. It describes the case of a patient affected by general paralysis having developed a neuroleptic malignant syndrome, thus the hypothesis what the neuroleptic malignant syndrome preferentially arises in subjects having underlying organic or metabolic problems and provides food for thought regarding the main medical and psychiatric overlaps, the use of dopaminergic agents and the behaviour to be adopted when dealing with a patient presenting with inaugural psychiatric symptomatology.