Voices Victor — Schizophrenia & Antipsychotic Side Effects (EPS, NMS, tardive dyskinesia)
Auditory hallucinations, then a rigid jaw, then a 104°F fever — stop the drug, call the doctor
Victor tells the nurse the radio is telling him to hurt himself, and he flinches at voices only he can hear. Weeks after starting an antipsychotic, his neck locks in a painful twist and, later, he spikes a fever with muscles rigid as a board.
Victor hears voices commenting on everything he does and believes the television is sending him messages. Antipsychotics control positive symptoms but carry extrapyramidal side effects: acute dystonia, akathisia and pseudoparkinsonism early on, tardive dyskinesia with long-term use, and neuroleptic malignant syndrome as a rare, life-threatening emergency with rigidity, fever and autonomic instability.
Read Voices Victor's full story →The story arc
The setup
Victor has stopped going to work, insists the television names him by name, and hears two voices arguing about him constantly.
The turn
Two days after starting haloperidol, Victor's neck suddenly twists to one side and he cannot straighten it, panicking that he is choking.
The crisis
Weeks later Victor is found rigid, diaphoretic, confused, with a temperature of 104°F and a heart rate of 130.
The save
The nurse stops the antipsychotic immediately, cools the patient, gives IV fluids, and anticipates dantrolene while monitoring for rhabdomyolysis.
NCLEX study section — Schizophrenia & Antipsychotic Side Effects (EPS, NMS, tardive dyskinesia)
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Mental Health
Take this chapter into practice questions on the same topic.