Table 1 Sternbach, Radomski and Hunter diagnostic criteria
From: Conundrums in neurology: diagnosing serotonin syndrome – a meta-analysis of cases
Sternbach | Radomski | Hunter | |
|---|---|---|---|
Co-incidence with the addition or increase in a known serotonergic agent to an established treatment regimen, at least three of the following features present: | Coincidence with the addition or increase in a known serotonergic agent (to an established treatment regimen), and the development of at least four minor or three major plus two minor symptoms: | In the presence of a serotonergic agent, symptom or symptom constellation: | |
Mental status changes (confusion, hypermania) Agitation Myoclonus Hyperreflexia Diaphoresis Shivering Tremor Diarrhea Incoordination Fever | Major | Minor | |
Mental | |||
• Consciousness | • Restlessness | ||
impairment | • Insomnia | • Spontaneous clonus • Inducible clonus AND agitation OR diaphoresis • Ocular clonus AND agitation OR diaphoresis • Tremor AND hyperreflexia • Hypertonic AND temperature > 38 °C AND ocular clonus OR inducible clonus | |
• Elevated mood | |||
• Semicoma/coma | |||
Neurological | |||
• Myoclonus | • Uncoordination | ||
• Tremor | • Dilated pupils | ||
• Shivering | • Akathisia | ||
• Rigidity | |||
• Hyperreflexia | |||
Vegetative | |||
• Fever | • Tachycardia | ||
• Sweating | • Tachy/dyspnea | ||
• Diarrhea | |||
• Hyper/hypotension | |||
• Clinical features not an integral part of the underlying psychiatric disorder prior to commencing the serotonergic agent. | |||
• Other aetiologies (e.g. infectious, metabolic or endocrine, substance abuse or withdrawal) have been ruled out. | • Other aetiologies (e.g. infectious, metabolic or endocrine, substance abuse or withdrawal) have been ruled out. | ||
• A neuroleptic drug had not been started or increased in dosage prior to the onset of the signs and symptoms listed above. | • A neuroleptic drug had not been started or increased in dosage prior to the onset of the signs and symptoms listed above. | ||