Clinical Experiences of Physicians and Nurses Recognising Neuroleptic Malignant Syndrome in Psychiatric Hospitals: An Interpretative Phenomenological Study

Abstract

Neuroleptic malignant syndrome (NMS) and metabolic neurological disorders can both present with altered consciousness, creating a diagnostic challenge in psychiatric emergency and intensive care services. This qualitative study explored how physicians and nurses experienced early recognition and management of patients with deteriorating consciousness in two referral psychiatric hospitals in Central Java, Indonesia. An interpretative phenomenological design involved 14 clinicians: two specialist physicians, six general practitioners and six nurses. Semi-structured interviews, reflective observation and a focus-group discussion were used to examine lived experiences; the thesis describes interpretative phenomenological analysis supported by triangulation, member checking and an audit trail. Its findings were organised into four domains: the experience of managing acute deterioration, early detection and differential diagnosis, interprofessional collaboration and staff development, and clinical reflection. Participants’ reported accounts highlighted the challenge of distinguishing NMS from metabolic or other neurological conditions when characteristic features develop over time. Familiar clinical warnings included hyperthermia, muscle rigidity, altered mental status and autonomic dysfunction; early review of causative medication and escalation to supportive management were central clinical concerns. The findings indicate that structured recognition pathways, clear professional responsibilities and reflective team learning warrant consideration, without establishing the effectiveness of any specific clinical protocol. The interpretations are contextual and should not be generalised as estimates of the prevalence of NMS or of treatment effects.