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The neuroleptic malignant syndrome (NMS) is a severe clinical condition, triggered by an idiosyncratic toxic response to drugs used in medical practice, mainly antipsychotics. Studies have found mortality rates of 10 to 20%.1 We report a case of NMS including signs of catatonia in a patient undergoing his first episode of psychosis, in which remission was achieved using electroconvulsive therapy (ECT). A 31-year-old man was admitted to our psychiatric emergency unit presenting with psychomotor agitation, withdrawal, uncooperativeness, stereotypy, and alternating perseveration with mutism. It was impossible to communicate with him. Three weeks before admission, he had become paranoid and had some auditory hallucinations. During the week before admission he started taking 1 mg risperidone per day. He has comorbid type 1 diabetes mellitus and no other diagnoses, and his only family history is an aunt with Schizophrenia. Due to severe agitation, he was given 10 mg of intramuscular (IM) olanzapine, which was ineffective, and 60 minutes later 5 mg haloperidol IM plus 50 mg promethazine IM. He had low fever (38oC), and the main abnormal results detected by the initial laboratory tests were as follows: leukocyte count 27,540 /mm3, with 11% bands, and lactate dehydrogenase (LDH) 266 U/L (81-234 U/L). Results of a second battery of laboratory tests, conducted within 24 hours of the first tests were as follows: creatinine 2.0 mg/dL, sodium 150 mmol/L, potassium 5.8 mmol/L, aspartate transaminase (AST) 163 U/L, lactate 9.7 mmol/L, and creatine phosphokinase (CPK) 10,351 UI/L. Additional tests, to rule out infection, found no significant abnormalities (blood and urine cultures, qualitative urinalysis, and chest X-ray) and a physical examination Eletroconvulsoterapia bitemporal com pulso ultra-breve para o tratamento de síndrome neuroléptica maligna em um primeiro episódio psicótico: um relato de caso

Bitemporal ultra-brief pulse electroconvulsive therapy for the treatment of neuroleptic malignant syndrome in a first psychotic episode: a case report