What monitoring parameters should be established for a patient recovering from NMS after discontinuation of antipsychotic medication?

After discontinuation of antipsychotic medication due to neuroleptic malignant syndrome (NMS), monitoring should focus on both physical and mental health parameters to detect relapse and ensure recovery. This includes regular clinical assessment for signs and symptoms of relapse of the underlying psychotic disorder, as relapse risk remains elevated after stopping antipsychotics and should be monitored for at least 2 years.

Physical monitoring parameters should include:

• Vital signs such as pulse and blood pressure at regular intervals to detect autonomic instability or cardiovascular complications.
• Regular measurement of weight and waist circumference to monitor metabolic health.
• Blood tests including fasting blood glucose or HbA1c and lipid profile to assess metabolic status.
• Monitoring for movement disorders or neurological symptoms that may indicate residual or emerging side effects.
• Close observation for any signs of infection or dehydration, as these can complicate recovery.

Mental health monitoring should include:

• Regular assessment of psychiatric symptoms to identify early signs of relapse.
• Monitoring adherence and tolerability if antipsychotic medication is reintroduced cautiously.

These monitoring activities are typically maintained by secondary care teams initially and may be transferred to primary care under shared-care arrangements once the patient is stable.

Gradual dose reduction of antipsychotics over at least 4 weeks is recommended to minimise relapse risk, with close monitoring during this period.

Overall, a multidisciplinary approach with clear communication between secondary and primary care is essential to ensure safe recovery and early detection of complications or relapse.

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