**Core Concept**
Malignant neuroleptic syndrome (NMS) is a rare but life-threatening neurological disorder associated with the use of antipsychotic medications, particularly first-generation (typical) antipsychotics. It is characterized by a combination of fever, muscle rigidity, altered mental status, and autonomic dysfunction.

**Why the Correct Answer is Right**
NMS is believed to result from an imbalance between dopamine and acetylcholine neurotransmission in the brain, with an excess of dopamine and a deficiency of acetylcholine. This imbalance leads to an overactivation of dopamine receptors, particularly the D2 subtype, which is thought to contribute to the development of NMS. The pathophysiology of NMS involves the involvement of several neurotransmitters and receptors, including dopamine, serotonin, and acetylcholine.

**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because NMS can indeed be seen with the use of first-generation antipsychotics, such as haloperidol and chlorpromazine, which are known to have a high risk of inducing NMS.
**Option B:** This option is incorrect because NMS has been reported with the use of second-generation antipsychotics, such as risperidone and olanzapine, although the risk is generally considered to be lower compared to first-generation antipsychotics.
**Option C:** This option is incorrect because NMS has been associated with the use of other classes of medications, including lithium and certain antidepressants, which can also lead to an imbalance in neurotransmitter systems.

**Clinical Pearl / High-Yield Fact**
A key clinical feature of NMS is the presence of fever, which is often accompanied by muscle rigidity and altered mental status. Early recognition and treatment of NMS are crucial to prevent long-term sequelae and improve patient outcomes.

**Correct Answer: D.**