The Daily PANCE and PANRE Extended Edition: Question 57

A patient is started on a new antipsychotic medication for his disorder. Three days later he develops altered consciousness, lead-pipe rigidity, diaphoresis, and catatonia. Vital signs reveal respiratory rate of 20, temperature of 105.6 degrees F, and pulse oximetry of 95% room air. Which of the following would be the most appropriate initial intervention in this patient?

A. Immediate oral SSRI's and Benadryl
B. Supportive care with fluids and antipyretics
C. IV antibiotics and naloxone
D. Intubation and mechanical ventilation

Answer: B

Supportive care with fluids and antipyretics

Neuroleptic malignant syndrome is characterized by extrapyramidal signs, blood pressure changes, altered consciousness, hyperpyrexia, muscle rigidity, dysarthria, cardiovascular instability, fever, pulmonary congestion, and diaphoresis. Controlling fever and fluid support are the best initial management. With a normal pulse oximetry, mechanical ventilation is not indicated.

Know Your Content Blueprint

Neuroleptic malignant syndrome is a common side effect of medications used to treat Schizophrenia. Schizophrenia is covered as part of the PANCE Psychiatry Blueprint and Psychiatry and Behavioral Health Post Rotation Exam Blueprint

Review Topic: Psychiatry: Schizophrenia and Schizophrenia (PANCE)