NBME question Can NMS has hallucination?

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A 52-year-old man is brought to the emergency department by his brother because of fever and muscular rigidity for 24 hours. He has been taking chlorpromazine for 4 days for agitation and insomnia. He was well until 2 days ago when he began to sweat profusely and feel agitated. He went to bed and began to have visual hallucinations. On examination today, he is agitated, disheveled, and yelling. His temperature is 39.2°C (102.5°F), pulse is 120/min, respirations are 24/min, and blood pressure is 150/100 mm Hg. Physical examination shows clammy skin and rigid extremities. Deep tendon reflexes are 2+ bilaterally. Hoffmann and Babinski signs are absent. On mental status examination, he appears to be having visual hallucinations. He is not oriented to person, place, or time. In addition to hydration, which of the following is the most appropriate next step in management?

A) Add acyclovir to the regimen

B) Add benztropine to the regimen

C) Add ceftriaxone to the regimen

D) Administer intravenous physostigmine

E) Discontinue chlorpromazine

Can NMS has hallucination?

This case really looks like NMS, I know NMS has confusion. chlorpromazine inhibit hallucination. Can it cause hallucination?

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It is possible, after all there is a state of psychomotor agitation. It is not typical though. However, the signs and symptoms of this case leads to NMS like you said, regardless of hallucination.
 
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