Is Risk of Neuroleptic Malignant Syndrome Increased in the Postpartum Period?

Sir: Although there is no definite consensus, many factors (e.g., high-potency neuroleptics, higher dose of neuroleptics, parenteral administration of neuroleptics, rapid dose escalation, concurrent use of lithium and neuroleptics, affective disorder, organic brain syndrome, agitation, fluid and electrolyte imbalances, shifts in cholinergic-dopaminergic balances, genetic factors) have been proposed to increase the risk for occurrence of neuroleptic malignant syndrome (NMS). However, due to the rarity of the syndrome, speculation about the etiologic importance of these factors is based on reviews of case reports or retrospective and prospective studies involving small sample sizes. It is likely that many cofactors that increase the vulnerability for the development of NMS are yet to be identified.