ScriptDetectionofSuspectedNeurolepticMalignant.docVIP

TRANSCRIPT Detection of Suspected Neuroleptic Malignant Syndrome: Three Case Examples The following transcript does not include graphics that appear on-screen throughout the program. INTRODUCTION NARRATOR: Worldwide, a significant number of people are taking neuroleptic medications as part of treatment regimens for schizophrenia, schizoaffective disorder, bi-polar disorder, and clinical depression. In addition, large numbers of the developmentally disabled and elderly are also taking neuroleptics. DSM4 reports that .07% to 1.4% of those taking neuroleptics will suffer a toxic reaction to neuroleptic medication, referred to as neuroleptic malignant syndrome, or NMS. NMS may be fatal for some patients, while other patients who survive may suffer permanent harm. However, with early detection, fatalities can be prevented and the incidence of permanent harm can be reduced. In Case Example 1, the patient died approximately 27 hours after administration of neuroleptic medication. In Case Example 2, the patient died about 52 hours after receiving neuroleptic medication. In Case Example 3, the patient recovered after a severe course of the syndrome. DSM IV reports that the presentation and course of neuroleptic malignant syndrome are quite variable. To detect suspected NMS, some clinicians consider that there are four categories of signs and symptoms to closely monitor. Unstable Vital Signs Rigidity Confusion Lab Abnormalities It is thought that when NMS occurs, the hypothalamus (the organ regulating vital signs) is destabilized by neuroleptic medication, triggering dysregulation of the autonomic system; blood pressure, respiration, pulse and temperature. Profuse sweating or diaphoreses is a common and easily identifiable sign. Rigidity occurs on a continuum from some rigidity to lead pipe rigidity. Though in some cases, rigidity is not reported. Significant confusion, or altered or impaired consciousness is another of the common early presenting signs.