Early Detection Key in Reducing Neuroleptic Malignant Syndrome Fatalities
Stephanie Doyle
Medscape Medical News 2007. © 2007 Medscape
October 4, 2007 (Kissimmee, Florida) — Psychiatric nurses must become more aware of the risk of neuroleptic malignant syndrome (NMS) and more vigilant in recognizing potential warning signs, a psychiatric nurse said here at the American Psychiatric Nurses Association (APNA) 21st Annual Conference.
"We need to know about the signs of NMS because people do die from this,'' said presenter Karen Tugrul, BSN, RN, a triage nurse for psychiatric emergency services at the University Hospital in Cincinnati, Ohio. "Anyone who is prescribed an antipsychotic medication is at risk. There's an enormous opportunity here for nursing intervention."
NMS is a potentially life-threatening adverse effect of antipsychotic medication, characterized primarily by fever, muscle rigidity, and changes in mental status, explained Ms. Tugrul, who also teaches in the Department of Psychiatry at the University of Cincinnati. The average medical center reports 5 cases per year.
APNA Board Member Ruth "Topsy" Staten, PhD, of Lexington, KY, told Medscape Nurses: "[NMS] is rare, but [fatal]. Quick recovery and management is important." Dr. Staten was not involved with the presentation.
Agitation and other signs of NMS often are misdiagnosed, resulting in increased dosages of drugs that may actually be the medications causing NMS to begin with.
"I think it behooves us as nurses to do a double-take when patients are agitated,'' Ms. Tugrul said. "Your intuition and your instincts are critical in what you do.... If your gut is telling you something is not right, pursue it."
The disorder typically develops over several days, but "sometimes this disorder just explodes on you," Ms. Tugrul said.
Although discontinuation of the offending antipsychotic medication or medications sometimes is all that is needed to treat NMS, intensive medical and nursing care are critical. Dopamine agonists, benzodiazepines, and dantrolene may each play a role in treatment of severe NMS, with or without rigidity.
A broad range of conditions may resemble NMS, including agitated delirium, benign extrapyramidal symptoms, malignant catatonia, drug withdrawal, heatstroke, infections, and serotonin syndrome. "The differential is complicated," Ms. Tugrul said.
Along with educating staff to recognize early symptoms of NMS and careful differentiation, the incidence and morbidity of the disorder may be reduced by using medications more conservatively and prescribing lower doses, Ms. Tugrul said.
"More isn't always better, and quicker isn't always better,'' she said.
Ms. Tugrul and Dr. Staten report no relevant financial relationships.
American Psychiatric Nurses Association 21st Annual Meeting: Presented October 4, 2007.