Neuroleptic malignant syndrome: high fever, rigidity, altered mental status - stop drug, emergency.
Before you read
Test yourself first: 3 questions
Question 1 of 3
A client taking risperidone reports breast enlargement and galactorrhea. The nurse recognizes these effects are related to which mechanism?
Answer: A. Risperidone strongly blocks dopamine, which raises prolactin levels (hyperprolactinemia), leading to gynecomastia, galactorrhea, menstrual irregularities, and sexual dysfunction. This is a recognized side effect that should be reported to the provider. It is not caused by increased thyroid hormone, low cortisol, or excess growth hormone. Understanding the prolactin link guides appropriate evaluation and possible medication adjustment.
Question 2 of 3
A client taking risperidone reports breast tenderness and milky nipple discharge, and a female client reports missed periods. Which adverse effect should the nurse identify?
Answer: A. Risperidone and other dopamine-blocking antipsychotics can elevate prolactin levels, causing galactorrhea (breast milk production), gynecomastia, menstrual irregularities, and sexual dysfunction. These findings reflect hyperprolactinemia and should be reported to the provider.
Question 3 of 3
A client taking risperidone develops a shuffling gait, masklike facial expression, and resting tremor. The nurse recognizes this as which medication-induced effect?
Answer: B. Drug-induced parkinsonism (pseudoparkinsonism) is an extrapyramidal effect of antipsychotics caused by dopamine blockade. It mimics Parkinson disease with bradykinesia, masklike facies, shuffling gait, cogwheel rigidity, and tremor, and may be treated with an anticholinergic agent.
Keep the streak going with more questions like these, each with a full rationale.
What is risperidone?
It treats both positive and negative symptoms with fewer EPS than typical antipsychotics, but at higher doses EPS and elevated prolactin can occur. A long-acting injectable form supports adherence.
Key points to remember
- Treats positive and negative symptoms of schizophrenia with a lower EPS rate than haloperidol.
- Of the atypicals, it most commonly raises prolactin (causing galactorrhea, gynecomastia, menstrual changes, sexual dysfunction).
- Causes metabolic effects: weight gain, hyperglycemia, and dyslipidemia (less than olanzapine/clozapine).
- Higher doses increase EPS risk; can still cause tardive dyskinesia and NMS.
- Causes orthostatic hypotension and sedation, especially at initiation.
- Available as a long-acting injectable to improve adherence.
Signs & symptoms
- ↑Prolactin → galactorrhea
- Gynecomastia, amenorrhea
- Weight gain, metabolic synd
Nursing priorities
- Monitor weight, fasting glucose, and lipids for metabolic syndrome.
- Assess for EPS, tardive dyskinesia (AIMS), and signs of NMS.
- Monitor for prolactin-related effects and report bothersome symptoms.
- Check for orthostatic hypotension; teach slow position changes.
- Promote adherence and assess therapeutic response to psychotic symptoms.
Labs & values
Patient teaching
- Report breast enlargement or discharge, menstrual changes, or sexual side effects.
- Monitor your weight; report increased thirst, urination, or hunger (high blood sugar).
- Rise slowly to avoid dizziness and falls.
- Report any uncontrolled movements, muscle stiffness, or high fever immediately.
Red flags: report now
- Neuroleptic malignant syndrome: high fever, rigidity, altered mental status - stop drug, emergency.
- Involuntary movements suggesting tardive dyskinesia.
- Marked hyperglycemia/new diabetes symptoms (polyuria, polydipsia).
- Severe orthostatic hypotension with falls.
References
Clinical references for this topic
