Characteristic features of a case of recurrent neuroleptic malignant syndrome

A 56-year old schizophrenic patient developed three episodes of neuroleptic malignant syndrome (nms) after age of 50. patient was under treatment with risperidone and clozapine during the first two episodes respectively. but no antipsychotic was ever used during the 45-month period between 2nd and 3rd lethal episodes of nms,and the patient was only treated with ect,and promethazine as needed base. patient used to show sub syndromal catatonia throughout this period. this might reflect a trait vulnerability to nms which for full expression of the disorder need some sort of state variable such as a drug.