A client who’s taking antipsychotic medication develops a very high temperature, severe muscle rigidity, tachycardia, and rapid deterioration in mental status. The nurse suspects what complication of antipsychotic therapy?
A. Agranulocytosis
B. Extrapyramidal effects
C. Anticholinergic effects
D. Neuroleptic malignant syndrome (NMS)
Correct Answer: D. Neuroleptic malignant syndrome (NMS)
A rare but potentially fatal condition of antipsychotic medication is called NMS. It generally starts with an elevated temperature and severe extrapyramidal effects. Neuroleptic malignant syndrome (NMS) is a life-threatening syndrome associated with the use of dopamine-receptor antagonist medications or with rapid withdrawal of dopaminergic medications. NMS has been associated with virtually every neuroleptic agent but is more commonly reported with the typical antipsychotics like haloperidol and fluphenazine. Classic clinical characteristics include mental status changes, fever, muscle rigidity, and autonomic instability.
Option A: Agranulocytosis is a blood disorder. Agranulocytosis is a condition in which the absolute neutrophil count (ANC) is less than 100 neutrophils per microlitre of blood. People with this condition are at a very high risk of severe infection. Broadly, it can be due to hereditary disease due to genetic mutation or acquired disease. Agranulocytosis can have various presentations, including fever, chills, sore throat, etc. It can be a life-threatening condition that requires prompt diagnosis and treatment.
Option B: Symptoms of extrapyramidal effects include tremors, restlessness, muscle spasms, and pseudoparkinsonism. Extrapyramidal side effects (EPS), commonly referred to as drug-induced movement disorders are among the most common adverse drug effects patients experience from dopamine-receptor blocking agents. It was first described in 1952 after chlorpromazine-induced symptoms resembling Parkinson disease. A variety of movement phenotypes has since been described along the EPS spectrum, including dystonia, akathisia, and parkinsonism, which occur more acutely, as well as more chronic manifestations of tardive akathisia and tardive dyskinesia.
Option C: Anticholinergic effects include blurred vision, drowsiness, and dry mouth. Anticholinergics are drugs that block the action of acetylcholine. Acetylcholine is a neurotransmitter, or a chemical messenger. It transfers signals between certain cells to affect how your body functions. They also help block involuntary muscle movements associated with certain diseases such as Parkinson’s disease. Sometimes, they’re used before surgery to help maintain body functions while a person is treated with anesthesia.