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A 55 year old white woman presented with a two day history of severe rigidity, hyperthermia, altered mental status, and autonomic dysfunction. She had been treated for paranoid-type schizophrenia with zuclopentixol for two years. Thirteen weeks before, zuclopentixol had been discontinued and she started treatment with olanzapine (10 mg/day). Two weeks before, olanzapine was stopped because of worsening of her schizophrenic symptoms and she started taking zuclopentixol again (30 mg/day). She did not use any other medications or drugs. The clinical picture happened in winter. On admission, the oral temperature was 40.3°C, blood pressure 110/70 mm Hg, pulse rate 125 beats/min, and respiratory rate was 30/min. There was prominent diaphoresis. The neurological examination was difficult to complete because of the patient's uncooperativeness. She did not follow commands or answer questions. His face was symmetric, and she had severe rigidity in neck, arms, and legs. Deep tendon reflexes were symmetric and the results of the Babinski test were equivocal. Extraocular movements and fundi were normal.
- What is your differential diagnosis for this case and what investigations would you perform?
- What is the treatment for this case?
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