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Neuroleptic Malignant Syndrome (NMS) -....... ANSWER...-
rare, life-threatening adverse effect caused by
antipsychotic meds
-may occur due to:
• disruption of dopamine receptors in the
anterior hypothalamus
• direct toxicity to muscle cells
• Psychological stressors that activate the ANS may
also play a role in triggering NMS
-onset of symptoms may occur 1-2 weeks after starting
or changing the causative medication
-Symptoms:
1
,• mental status changes
• agitation
• confusion
• catatonia
• muscle rigidity ("lead pipe" rigidity)
• hyperthermia
• excessive salivation
• autonomic instability (labile blood pressure & heart
rate)
• elevated Serum creatine kinase (CK) levels
Neuroleptic Malignant Syndrome (NMS) Tx -
....ANSWER...-immediate intervention to stabilize vital
signs, reduce fever, and control agitation
-frequently admitted to ICU
-causative agent should be discontinued immediately
-symptoms typically resolve 1-2 weeks after tx is
initiated
Serotonin Syndrome vs NMS - .. ANSWER...-Serotonin
Syndrome
• Dilated Pupils
2
,• Headache
• Shivering
• Dysrhythmias
• Hyperreflexia
• Clonus
-NMS
• Drooling
• Catatonia
• Rapid changes in BP
• Increased serum creatine kinase (CK)
• Hyporeflexia
-Both
• Agitation
• High BP
• High fever
• Confusion
• Rigid muscles
3
, Hailey is a 20-year-old brought to the emergency
department by EMS to evaluate a laceration. Her
roommate found her sitting on their sofa with blood
streaming down her arms and a knife beside her. Her
roommate immediately called 911 and applied pressure to
the wound. The triage nurse assessed the wound as
superficial. After dressing the wound, the PMHNP was
called to perform a psychiatric evaluation. On exam, she is
awake and alert but appears withdrawn and hesitant to
speak. She continues to repeat, "I don't know why this
keeps happening." Hailey denies medical or psychiatric
history; the PMHNP notes bilaterally linear scarring on
her arms. Hailey admits to self-injury behaviors and states
she has been using cutting as a coping mechanism for
4