At the March edition of the University of Port Harcourt Teaching Hospital Ground Rounds, the department of Neuropsychiatry featured the advanced management of *Neuroleptic Malignant Syndrome (NMS)* and the necessity of multidisciplinary collaboration.
Coordinating the session was the coordinator of Ground Rounds, Prof. O.N. Ekeke, who appreciated the Neuropsychiatric team and highlighted the essence of the ground rounds . The event was well-attended by medical professionals, including consultants, resident doctors, medical students, and healthcare stakeholders. The presentation gave opportunity for interactive discussion that highlighted the complexities of NMS, its management strategies, and the importance of a team-based approach in handling psychiatric emergencies.
Neuroleptic Malignant Syndrome (NMS) is a psychiatric emergency though rare but life-threatening reaction to certain psychiatric medications, primarily antipsychotics.
Dr. Iberedem David , the first speaker of the event provided an in-depth analysis of NMS, including its clinical presentation, causes, and risk factors. She highlighted symptoms such as high fever, muscle stiffness and unconsciousness. The discussion also covered the primary causes of NMS, including the use of antipsychotic medications for conditions like schizophrenia and bipolar disorder, as well as instances where sudden changes in medication trigger the condition.
Dr. David presented three compelling cases spanning two decades of clinical intervention involving patients with different psychiatric backgrounds who developed NMS. The cases demonstrated the diverse presentations of the syndrome and the challenges in diagnosis and management. The discussion emphasized the importance of recognizing early warning signs for diagnosis and tailoring treatment approaches to individual patient needs.
The presentation also addressed key risk factors associated with NMS, including medication-related risks such as high-dose antipsychotics, rapid dose increases, sudden medication changes, and the use of multiple dopamine-blocking drugs. Patient-related risks were also discussed, with factors like male sex, young adulthood, and brain disorders contributing to susceptibility. Other contributing factors such as sudden discontinuation of dopamine-boosting drugs, the use of mood stabilizers and stimulants, and environmental triggers like hot weather were examined. The incidence rate of NMS was noted to range between 0.02% and 0.04%, emphasizing its rarity but significant impact when it occurs.
A special highlight of the session was the discussion on Neuropsychiatric Systemic Lupus Erythematosus (NPSLE). Systemic Lupus Erythematosus (SLE) is an autoimmune disease that can affect virtually all organs, including the brain. The presentation focused on the neurological and psychiatric symptoms associated with SLE, which occur in a significant percentage of patients. These symptoms include cognitive dysfunction, seizures, mood disorders and psychosis.
The key takeaways from the discussion reinforced the importance of early recognition of NMS for timely intervention, the necessity of collaboration among specialists to optimize treatment outcomes on NMS cases.
Revealing from the case studies, of the three patients, two were medical doctors. Medical stakeholders advocated for appropriate counseling and support groups for students in medical colleges, as well as appropriate guidance for paediatric and young adults to get support and necessary referrals to the Neuropsychiatric team for timely intervention and avert mortality associated with NMS.
On behalf of the Chief Medical Director, Prof. Henry A.A. Ugboma, Chairman Medical Advisory Committee, Prof. Datonye Alasia, host of the hospital ground rounds- and hospital management DCMAC , Professor O.B. Braimoh commended the Neuropsychiatric, Anaesthetic, Pharmacy team for the success recorded in the surviving case from NMS . He encouraged more collaborative effort in the multidisciplinary approach to patient care. He assured of management’s commitment to ensure necessary support for more advancement in training, research and care as an institution.
