Which class of antipsychotics is most commonly associated with neuroleptic malignant syndrome?

Which class of antipsychotics is most commonly associated with neuroleptic malignant syndrome?

• A. Second-generation antipsychotics
• B. High-potency first-generation antipsychotics
• C. Atypical antipsychotics
• D. Antidepressants

Answer: (B)

NMS occurs when there is excessive dopaminergic blockade in the brain, especially from potent dopamine D2 receptor antagonism. High-potency first-generation antipsychotics cause stronger and faster D2 blockade in motor and thermoregulatory pathways, which makes them the class most commonly linked to neuroleptic malignant syndrome. While second-generation (atypical) antipsychotics can also trigger NMS, they do so less often because their dopamine blockade is less intense and they also affect serotonin pathways, which moderates risk. Antidepressants are not antipsychotics and are not the typical source of NMS.

NMS occurs when there is excessive dopaminergic blockade in the brain, especially from potent dopamine D2 receptor antagonism. High-potency first-generation antipsychotics cause stronger and faster D2 blockade in motor and thermoregulatory pathways, which makes them the class most commonly linked to neuroleptic malignant syndrome. While second-generation (atypical) antipsychotics can also trigger NMS, they do so less often because their dopamine blockade is less intense and they also affect serotonin pathways, which moderates risk. Antidepressants are not antipsychotics and are not the typical source of NMS.