有些 NMS 病例比已发布报道中的那些要轻微,可能反映了对这一综合征风险的认知增强以及干预更及时,但也可能是 NMS 临床严重程度范围内的自身表现。相关的死亡率因研究的不同而不同,[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
估计 NMS 的复发率高达 30%,但是没有关于复发率的可靠数据。通常建议延迟再次给药直至综合征完全消退后至少两周。再次给药应在密切监测(包括进行合适的实验室检查)下缓慢进行。