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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.