Neuroleptic Malignant Syndrome and Catatonia

00:00 Now, neuroleptic malignant syndrome is a very noteworthy side effect coming from antipsychotics.

00:07 So this is life-threatening. It’s characterized by a fever, altered mental status, muscle rigidity, and autonomic dysfunction.

00:16 This often can occur on exams, so let’s take a moment to talk about it.

00:20 It’s more common in males. In fact, probably most common in young African American males in their 20s.

00:27 Although it’s a significant side effect, thank goodness, it is rare but still important to know about, especially on exams.

00:34 And it’s a true medical emergency that can in fact lead to death.

00:38 So in your assessment, what you’re going to look for when determining whether or not somebody has neuroleptic malignant syndrome.

00:46 Well, before they actually will develop the syndrome, it’s usually preceded by the patient being in a catatonic state.

00:54 Then they’ll develop a fever, instability like tachycardia, blood pressure changes, and they'll be sweating profusely.

01:02 They may have a leukocytosis, a tremor, elevated CPK, and also rigidity.

01:08 Fever and rigidity are really the two hallmarks of NMS that you want to be looking for.

01:14 So they may also have muscle spasms, trouble swallowing.

01:19 They may have some parkinsonian symptoms, and sustained motion or restlessness.

01:25 They may have uncontrollable repetitive movements.

01:29 We already mentioned the fever, rigidity, unstable vital signs. And you’re looking for blood work that shows a high CPK, high potassium, and elevated white blood cells.

01:38 So there's a lot of different ways to treat the patient with NMS.

01:42 You're probably gonna be thinking of doing something like beta blockers, benzodiazepines, of course, stop the offending agent.

01:49 Treat them with Dantrolene, cool them, and give them IV hydration and fluids.

01:53 And consider switching to atypical agent or newer antipsychotic.

02:00 Something important to note is that unlike what many people think, NMS is not actually an allergy to a medication.

02:07 It’s a very adverse and bad reaction, but it doesn’t mean that somebody can never take an antipsychotic again or try different antipsychotic later.

02:17 You simply want to treat the emergency, let the patient stabilize, and it’s actually okay to slowly introduce an antipsychotic in the future. So NMS is not an allergy.

02:28 Catatonia is a behavioral symptom that is diagnosed in patients who are ill with an underlying psychiatric and or general medical disorder.

02:39 It requires the presence of at least three of the following stupor a decreased psychomotor activity or decreased reactivity to the environment.

02:50 Number two, cataplexy passively allowing the examiner to position the body or a part of the body.

02:58 Waxy flexibility, a slight even resistance to positioning by the examiner as inventing a candle.

03:06 Mutism. Lack of verbal response.

03:09 Not applicable to patients with an established aphasia and negativism.

03:15 Motive was to resist ance to instructions or external stimuli.

03:19 Posturing.

03:21 Voluntarily maintaining a position of the body or a body part against gravity for a long time.

03:29 Mannerisms which are odd.

03:31 Movements stereotyped, which are repetitive.

03:36 Movements that are not goal directed and are often awkward or stiff.

03:41 Agitated or excessive motor activity that is purposeless and not influenced by external stimuli.

03:49 Grimacing Echo Lilia which is the mimicking of another person's speech.

03:55 Echo Proxy to the mimicking of another person's movements.