Neuroleptic malignant syndrome: A case report.

Electroconvulsive therapy (ECT) is an increasingly popular treatment for drug-resistant depression that may have utility for some patients with neuroleptic malignant syndrome (NMS) who are unresponsive to pharmacotherapy. Using a case study as an example, this article discusses the diagnosis of a patient with NMS, the use of ECT as a treatment for NMS, and the importance of nursing care for these patients.

Improving Psychiatric Nurses' Detection of Neuroleptic Malignant Syndrome.

Patients with psychiatric disorders receive nursing care in psychiatric units, medical units and long-term care facilities. Like other patients, their well-being is reliant upon knowledgeable caregivers. The pharmacological interventions that patients are dependent on can have catastrophic effects; of particular concern is Neuroleptic Malignant Syndrome (NMS). This article affords a succinct review of the literature related to NMS and provides suggestions for psychiatric nurse educators to facilitate early recognition, thereby reducing mortality and morbidity. Emphasis is placed on educational tools to help reduce under-detection. A case study illustrates how under-detection can lead to a near fatal outcome.

[Applying Neuman's Systems Model to a neuroleptic malignant syndrome psychiatric patient and his caregiver].

This article describes a nurse's experience using Neuman's Systems Model to care for a chronic psychiatric patient and his caregiver. The patient was diagnosed as suffering from neuroleptic malignant syndrome (NMS). Nursing care described in this article was administered from October 23 to December 4, 2007. The patient developed NMS in the third month of a three-month period of hospitalization, which endangered his life as well as the health of his caregiver. Nursing care was provided to the patient and his caregiver based on Neuman's Systems Model, which included assessments of intrapersonal, interpersonal, and extra-personal forces as well as of environmental factors affecting the health of the patient and his caregiver. The four nursing care issues identified included: existing self-care deficit, sensory/perceptual alteration, sleep pattern disturbance, and caregiver role strain. Following Neuman's systems model, primary, secondary, and tertiary prevention were used to strengthen the flexible lines of defense, internal lines of resistance, and supporting existing strengths of both patient and caregiver, as well as to conserve client system energy. Significant improvements in patient and caregiver abilities were apparent in nursing intervention outcomes. This experience shows the Neuman's systems model to be an efficient model in psychiatric nursing care.

Neuroleptic malignant syndrome.

Early recognition of this drug-induced condition can prevent death.

Catastrophic consequences secondary to psychotropic drugs, Part 1.

The use of psychotropic drugs has dramatically changed the lives of many; yet as often occurs with technological advances, negative outcomes can be encountered. Potentially fatal reactions to neuroleptic drugs and serotonin-enhancing agents (e.g., antidepressants) have been presented in Part 1, with the intent of alerting and informing psychiatric nurses. Part 2 will complete this series on catastrophic consequences of psychotropic drugs with a discussion of agranulocytosis and lithium toxicity.

Neuroleptic malignant syndrome: an assessment of registered psychiatric nurses' knowledge.

Neuroleptic Malignant Syndrome (NMS) is a potentially fatal complication of neuroleptic use and is frequently underdiagnosed by medical and nursing staff. The current project was undertaken to assess the knowledge registered psychiatric nurses (RPN) have of the signs, symptoms and interventions to be initiated in cases of NMS. A total of 126 RPN employed in a large tertiary inpatient facility and community mental health centre responded to a self-completed questionnaire. The results indicate that while the RPN in the study's sample demonstrated adequate knowledge of NMS, there was evidence to suggest that these RPN may actually lack confidence in their ability to identify and initiate appropriate interventions in suspected cases of NMS. Although RPN employed in the rehabilitation and psychogeriatric areas of the hospital had more years of experience in the mental health field, their overall knowledge of NMS was significantly lower than that of RPN employed in other clinical settings (F = 3.35; d.f. = 5119; P = 0.007). The findings underscore the importance of ongoing education for RPN employed within clinical mental health settings.

Neuroleptic malignant syndrome: do we know enough?

This study aimed to examine health care professionals' knowledge of neuroleptic malignant syndrome (NMS). A meta-analysis of 16 pieces of international literature on the subject, published in the decade 1980-1990, identified five areas of knowledge which their authors felt were the most important aspects of the syndrome. These included: being able to define the condition; knowing what drugs were associated with the onset of NMS; being aware of the common manifestations of the disorder; having knowledge of other conditions which have similar symptoms to NMS, and how the syndrome is treated. A multiple-choice questionnaire was administered to a non-randomized convenience sample of 40 pharmacists, doctors and nurses in the United Kingdom, and to 30 nurses in six other countries (India, Germany, Holland, Japan, USA and France). Two open-ended questions were also asked of the participants to ascertain their attitude to having knowledge of NMS. Analysis of the responses showed that the majority of health care professionals tested in this way did not know enough about NMS to aid early detection of the syndrome and to prevent loss of life.

Neuroleptic malignant syndrome: critical factors.

Although NMS is a rare complication of neuroleptic drug use, it is potentially fatal. Nursing care is directed at careful assessment, accurate treatment, and reduction of complications. Further studies should focus on prevention and treatment.

Neuroleptic malignant syndrome: a dangerous complication of neuroleptic therapy.

Neuroleptic malignant syndrome is a potentially fatal syndrome that can occur in patients taking neuroleptics or other psychotropic drugs. It is characterized by muscle rigidity, hyperthermia, altered mentation, autonomic dysfunction, increased CPK and leukocytosis. A primary factor in NMS may be a decrease in functioning of dopaminergic neurons. Treatment usually consists of discontinuation of the neuroleptic drug, drug therapy with bromocriptine and dantrolene and supportive measures. The key to successful medical and nursing management is aggressive supportive care with a focus on preventing complications. With the frequency of administration of neuroleptic drugs, neuroscience nurses should be aware of this potentially lethal complication of neuroleptic therapy.

Neuroleptic malignant syndrome: liability in nursing practice.

In the summer of 1991, the malpractice case Reyes v Houston International Hospital et al was settled for an amount in excess of $600,000. The case involved the psychiatric treatment received by Marjorie Reyes, a 27-year-old Latin-American mother of three, who was admitted to a psychiatric unit in late October 1986 with a diagnosis of atypical psychosis. Malpractice was charged because her treatment failed to meet any reasonably expected outcome for atypical psychosis. In fact, Reyes developed neuroleptic malignant syndrome (NMS) as a direct result of the antipsychotic medications she was administered. Her treatment outcome was nearly fatal and caused permanent, serious neurological disabilities. The litigation implicated the nursing care delivered in a psychiatric setting. This unfortunate situation illustrates general principles of legal liability in nursing practice as well as offers a unique opportunity to review NMS and to examine the specific implications for the assessment and evaluation of the side effects of antipsychotic medications. Additionally, methods of behavioral control, specifically as they relate to concepts concerning the use of medications, the importance of documentation, and the manner in which nurses plan care, were also addressed in the case. It is important for professionals to be familiar with general legal concepts and liabilities, the potential of the development of this serious side effect, and how clinical decisions regarding the administration of both routine and as-needed medications may incur legal accountability.