Neuroleptic malignant syndrome (NMS) is a very serious disorder that generally develops from taking neuroleptic medications. These drugs are also called antipsychotics and are frequently prescribed for mental health conditions that include elements of psychosis like bipolar I and schizophrenia. Most neuroleptics, including medications like Zyprexa® and Giodon® (some of the newest developed) contain warnings regarding potential of developing neuroleptic malignant syndrome.
The condition is best diagnosed early, and treatment usually involves taking a patient off any neuroleptics and possibly intensive care hospitalization while a patient recovers. The main symptoms of neuroleptic malignant syndrome are identified by the mnemonic FEVER, where each letter stands for the following: Fever, Encephalopathy, Vitals unstable, Elevated Enzymes, and Rigid muscles. In laymen’s terms, most notable is extremely rigid muscles with high fever. Blood pressure tends to be variable and high, patients may be delirious or unconscious, and bloodwork shows an elevated level of the enzyme creatine phosphokinase (CPK).
Naturally, doctors are most helped when they understand the patient is on a neuroleptic medication, especially if patients have just started taking the drug. However, the condition, though more rare, can develop in patients coming off certain medications that treat the symptoms of Parkinson’s disease, so taking neuroleptics is not the only cause of neuroleptic malignant syndrome. As mentioned, most people who develop the condition are new to taking a specific medication, but sometimes NMS can develop when people have been on a certain medication for a very long time.
When neuroleptic malignant syndrome is recognized and treated immediately, survival is very good. Failure to recognize and treat the condition can result in death, but statistics are currently unclear on how often this occurs. Some place mortality rate as high as 70%, but this must clearly relate to the condition untreated, since outcome is good for people who are hospitalized and treated right away.
One of the significant challenges of treating people with neuroleptic malignant syndrome is those newly prescribed an antipsychotic may not report the condition, and if the medication is not working effectively, they may already be experiencing some delusions or psychotic symptoms. A person may not fully understand the nature of the drugs they are taking, especially in the early stages of treatment for a severe psychiatric illness. This might indicate, especially for those suffering from psychotic symptoms, that neuroleptics are best diagnosed in a hospital setting, where patients can be watched until they are mentally stable and able to report dramatic health changes.
If you have had an episode of NMS, it doesn’t mean that you can’t take a neuroleptic again, though you must be carefully watched and introduced to the new medication slowly. There is a concern that those who have had NMS may be more likely to develop adverse reactions to anesthesia. Anyone who has previously had NMS should inform doctors and surgeons prior to any surgery so that anesthesiologists can create the safest plan to proceed with an operation.
