EVIDENCE LIBRARY
Diazepam in a paliperidone-associated NMS case: symptom control within a broader diagnosis
A case report describes benzodiazepine use during supportive treatment of suspected neuroleptic malignant syndrome after a long-acting antipsychotic.
A case report describes benzodiazepine use during supportive treatment of suspected neuroleptic malignant syndrome after a long-acting antipsychotic.
The sequence of deterioration
The patient, a 51-year-old man with schizophrenia, received paliperidone palmitate during hospitalization after refusing oral treatment. Within days he developed fever, tachycardia, generalized rigidity, mutism, confusion, dehydration, and refusal of intake. Creatine phosphokinase was elevated, and a pulmonary infiltrate complicated the assessment.
The authors considered an atypical presentation of neuroleptic malignant syndrome. Intensive care treatment included fluids, antipyretics, empirical antibiotics, and diazepam. The report describes gradual improvement and eventual recovery.
Why treatment response does not isolate cause
The benzodiazepine was one part of a multicomponent care plan. Improvement cannot identify diazepam as the sole effective treatment, establish an optimal regimen, or prove the diagnosis by itself. Infection and other explanations were considered in the clinical reasoning.
For toxicological review, distinguish the medicine suspected of precipitating the syndrome from medicines later administered to manage it. A diazepam detection after hospitalization may reflect therapeutic care, not the initiating exposure. This report provides a clinical example of that chronology, while its single-patient design cannot establish incidence or comparative treatment effectiveness.
Source paper
Original analysis of the supplied journal article, identified as PMC12933270.