Overview
Clinical Meaning
The nurse managing schizophrenia independently monitors complex antipsychotic regimens, recognizes and responds to emergent side effects, manages acute psychotic episodes includ...
The nurse managing schizophrenia independently monitors complex antipsychotic regimens, recognizes and responds to emergent side effects, manages acute psychotic episodes including de-escalation and medication administration, and coordinates long-term rehabilitation. EPS management requires systematic recognition: Type 1 Acute dystonia (hours to days after initiation; sustained muscle contraction; treat with anticholinergic IM); Type 2 Akathisia (days to weeks; restlessness, inability to sit still; commonly mistaken for anxiety or agitation, leading to inappropriate dose increases which worsen symptoms; treat with beta-blocker, benzodiazepine, or dose reduction); Type 3 Pseudoparkinsonism (weeks to months; bradykinesia, cogwheel rigidity, pill-rolling tremor, masked facies; treat with anticholinergic or dose reduction); Type 4 Tardive dyskinesia (months to years; involuntary choreiform movements especially of mouth, face, tongue; often irreversible; assess with AIMS scale every 6 months; treat with valbenazine or deutetrabenazine). NMS is the most feared antipsychotic complication: hyperthermia, severe rigidity, autonomic instability, elevated CK (often above 1000), leukocytosis. Mortality is 5-20%. Management: stop antipsychotic immediately, aggressive cooling, IV hydration, dantrolene (1 mg/kg IV, muscle relaxant), bromocriptine (2.5-10 mg PO TID, dopamine agonist to reverse D2 blockade), ICU admission.
