The Myth of Elevated Serum Creatine Phosphokinase Level and Neuroleptic Malignant Syndrome

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Abstract
The 1980s witnessed the honeymoon between American psychiatry and an enigmatic and mysterious drug complication called neuroleptic malignant syndrome (NMS). I fear that the 1990s are witnessing the same in British psychiatry. Gone is the era when case reports in British literature described the syndrome without identifying it by name (Allan & White, 1972; Moyes, 1973), ostensibly owing to lack of awareness. Probably, no one had bothered to read the original description in the French-language literature (Delayet al,1960). The pendulum has now swung to the other extreme. Every known drug-related complication is being labelled NMS. In the US, Addonizioet al(1986) suggested a ridiculously high incidence figure of 12.2%. The same trend for overdiagnosis is seen in the recent case report by Dalkin & Lee (1990). The authors of this case report seem to have forgotten that NMS is an idiosyncratic adverse drug reaction which is dose-independent. There is no reason to label every neuroleptic overdose as NMS on grounds of raised creatine phosphokinase (CPK) level.