由于当前可用证据是非决定性证据,因此 NMS 的实际发病率未知。[14]Gurrera RJ, Simpson JC, Tsuang MT. Meta-analytic evidence of systematic bias in estimates of neuroleptic malignant syndrome incidence. Compr Psychiatry. 2007;48:205-211.http://www.ncbi.nlm.nih.gov/pubmed/17292713?tool=bestpractice.com在考虑已发表的估计值时,有一项重要的限制,即这些数据几乎只有发病比例(一段时间的新增病例数量除以该时间段开始时处于风险中的人数),而不是真正的发病率(一段时间的新增病例数量除以处于风险中的人次)。[14]Gurrera RJ, Simpson JC, Tsuang MT. Meta-analytic evidence of systematic bias in estimates of neuroleptic malignant syndrome incidence. Compr Psychiatry. 2007;48:205-211.http://www.ncbi.nlm.nih.gov/pubmed/17292713?tool=bestpractice.com过去 20 年来,报告的发病率出现降低,这可能反映了安全意识提高、警惕性更高以及临床干预更及时。其他可能因素包括:系统报告偏倚,[14]Gurrera RJ, Simpson JC, Tsuang MT. Meta-analytic evidence of systematic bias in estimates of neuroleptic malignant syndrome incidence. Compr Psychiatry. 2007;48:205-211.http://www.ncbi.nlm.nih.gov/pubmed/17292713?tool=bestpractice.com倾向使用第二代抗精神病药物 (second-generation antipsychotic medication, SGA) 的实践演变,以及谨慎使用高初始剂量的抗精神病药物。
据报告,相较于女性患者而言,NMS 更常见于男性患者,但是更大型的研究并没有得出一致结论。[15]Nielsen RE, Wallenstein Jensen SO, et al. Neuroleptic malignant syndrome - an 11-year longitudinal case-control study. Can J Psychiatry. 2012;57:512-518.http://www.ncbi.nlm.nih.gov/pubmed/22854034?tool=bestpractice.com已患有的结构性脑部异常、紧张症和高龄与风险增加相关。[3]Caroff SN, Mann SC. Neuroleptic malignant syndrome. Med Clin North Am. 1993;77:185-202.http://www.ncbi.nlm.nih.gov/pubmed/8093494?tool=bestpractice.com[16]Takubo H, Harada T, Hashimoto T, et al. A collaborative study on the malignant syndrome in Parkinson's disease and related disorders. Parkinsonism Relat Disord. 2003;9(suppl 1):S31-S41.http://www.ncbi.nlm.nih.gov/pubmed/12735913?tool=bestpractice.com与之相关的死亡率存在差异,[3]Caroff SN, Mann SC. Neuroleptic malignant syndrome. Med Clin North Am. 1993;77:185-202.http://www.ncbi.nlm.nih.gov/pubmed/8093494?tool=bestpractice.com[5]Hasan S, Buckley P. Novel antipsychotics and the neuroleptic malignant syndrome: a review and critique. Am J Psychiatry. 1998;155:1113-1116.http://www.ncbi.nlm.nih.gov/pubmed/9699705?tool=bestpractice.com[6]Levinson DF, Simpson GM. Neuroleptic-induced extrapyramidal symptoms with fever: heterogeneity of the 'neuroleptic malignant syndrome'. Arch Gen Psychiatry. 1986:43:839-848.http://www.ncbi.nlm.nih.gov/pubmed/2875701?tool=bestpractice.com[14]Gurrera RJ, Simpson JC, Tsuang MT. Meta-analytic evidence of systematic bias in estimates of neuroleptic malignant syndrome incidence. Compr Psychiatry. 2007;48:205-211.http://www.ncbi.nlm.nih.gov/pubmed/17292713?tool=bestpractice.com[17]Pope HG Jr, Keck PE Jr, McElroy SL. Frequency and presentation of neuroleptic malignant syndrome in a large psychiatric hospital. Am J Psychiatry. 1986;143:1227-1233.http://www.ncbi.nlm.nih.gov/pubmed/2876647?tool=bestpractice.com[18]Keck PE Jr, Pope HG Jr, McElroy SL. Declining frequency of neuroleptic malignant syndrome in a hospital population. Am J Psychiatry. 1991;148:880-882.http://www.ncbi.nlm.nih.gov/pubmed/1675841?tool=bestpractice.com[19]Neuhut R, Lindenmayer JP, Silva R. Neuroleptic malignant syndrome in children and adolescents on atypical antipsychotic medication: a review. J Child Adolesc Psychopharmacol. 2009;19:415-422.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861947/http://www.ncbi.nlm.nih.gov/pubmed/19702493?tool=bestpractice.com但是两项大型研究得出 8.4% 至 8.6% 的死亡率。[15]Nielsen RE, Wallenstein Jensen SO, et al. Neuroleptic malignant syndrome - an 11-year longitudinal case-control study. Can J Psychiatry. 2012;57:512-518.http://www.ncbi.nlm.nih.gov/pubmed/22854034?tool=bestpractice.com[20]Nakamura M, Yasunaga H, Miyata H, et al. Mortality of neuroleptic malignant syndrome induced by typical and atypical antipsychotic drugs: a propensity-matched analysis from the Japanese Diagnosis Procedure Combination Database. J Clin Psychiatry. 2012;73:427-430.http://www.ncbi.nlm.nih.gov/pubmed/22154901?tool=bestpractice.com