NR 607 Week 2 Assignment; Standardized Procedure Worksheet - Neuroleptic Malignant Syndrome (NMS)

occurrence of NMS is within weeks or days after increasing the dose or initiating use of an antipsychotic; however, evidence suggests that sudden withdrawal of dopamine agonists like levodopa in patients with Parkinson’s disease can result in NMS (Perry et al., 2022). Immediate intervention is necessary due to the progression and severity of the symptoms. The interventions include aggressive supportive care, discontinuing offending agents, and pharmacologic management using muscle relaxants and dopamine agonists. NMS mortality rate ranges between 10% and 20%, necessitating early recognition, intervention, and prompt treatment. c. Incidence and prevalence Although rare, NMS is an adverse and serious reaction to dopamine-blocking agents. According to Gurrera et al. (2022), NMS incidence is estimated to be 0.02% to 3.23% among people receiving antipsychotic medication. However, the actual prevalence figures could be understated because of underreporting or misdiagnosis, more so in atypical presentation cases. While the common association of NMS is with first-generation antipsychotics (typical), including chlorpromazine and haloperidol, cases have been reported with atypical (second- generation) antipsychotics like clozapine, risperidone, and olanzapine. While this condition can affect individuals of all ages, it is predominant in young adult males and has an approximate female-to-male ratio of 1:2 (Gurrera et al., 2022). Susceptibility to NMS is enhanced by certain risk factors such as catatonia, dehydration, rapid escalation or higher doses of antipsychotic medications, agitation, intramuscular administration, and pre-existing neurological disorders like Parkinson’s disease. The risk of this condition among psychiatric populations is significantly higher among bipolar disorder and schizophrenia patients, primarily when admitted inpatient, where there are frequent medication adjustments. Gurrera et al. (2022) state that “Despite • The patient may also experience autonomic symptoms like difficulty swallowing, nausea, excessive thirst, and profuse sweating (diaphoresis). • Reports of chest discomfort, shortness of breath, dizziness, or palpitations may exist, an indicator of cardiovascular problems. According to Rizos et al. (2021), if the symptoms are left untreated, they may result in multi-organ failure, coma, and seizures. Initially, patients may describe their symptoms as having an “intense flu-like illness” or “feeling extremely unwell” due to the rapid and acute onset progression of NMS. b. Physical exam findings The focus of a physical exam for a patient suspected to suffer from NMS is on systemic, autonomic, and neurological findings. Lead-pipe rigidity is a major physical sign, indicated by all muscle groups resisting passive movements, unlike in Parkinsonism, where there is cogwheel rigidity. It is also common for patients to experience slowed movement and tremors (bradykinesia). Neurologically, severe cases may include patients progressing to a coma or a state of stupor; however, mild cases may include patients experiencing decreased response to verbal stimuli, staring, or mutism. Examinations can reveal autonomic instability, with findings including excessive sweating, high fever (>38.5°C), tachypnea (rapid breathing), tachycardia (>100 bpm), and labile blood pressure (hypotension or hypertension). As a result of dysregulated vasodilation, flushing or skin pallor may be experienced by patients (Rizos et al., 2021). Rhabdomyolysis-related complications should be assessed through a comprehensive exam to check for decreased urine output (an