Schizophrenia

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.