A 33-Year-Old Man Is Hospitalized for Depression with Psychotic Features

A 33-year-old man is hospitalized for depression with psychotic features.  The patient had been on outpatient phenelzine therapy for major depressive disorder but stopped taking the medication 3 weeks ago because he did not feel that it was helping.  Two days ago, he was brought to the emergency department due to worsening depressive symptoms and new auditory hallucinations.  He was started on citalopram and risperidone and admitted to the inpatient psychiatric unit.  He has not been receiving any other medications.  This morning, he was found to have acute-onset confusion and high fever.  Temperature is 39.4 C (102.9 F) , blood pressure is 160/80 mm Hg, pulse is 118/min, and respirations are 16/min.  On examination, the patient is disoriented and unable to attend to the interview.  He has severe muscle stiffness but no hyperreflexia.  The remainder of the examination is within normal limits.  Laboratory tests are ordered, but results are not yet available.  Which of the following is the most likely provisional diagnosis in this patient?

A) Malignant catatonia
B) Malignant hyperthermia
C) Monoamine oxidase inhibitor discontinuation symptoms
D) Neuroleptic malignant syndrome
E) Serotonin syndrome

Correct Answer:

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