During my third year of graduate school, in addition my classes, I completed a 1-year diagnostic externship at a state hospital. Most of that year was spent interviewing patients, administering tests and writing reports. We did a little overnight ER duty, but not much.
Prior to that training year, I had only been on a psych unit twice before--once to drop something off to a classmate who was a tech at another hospital and once to visit a relative who was in an eating disorders program.
On my first day of the externship, as I was approaching the front double doors to the building where I was assigned, both doors abruptly flew open from the inside. A couple of emergency techs were wheeling out a dead body on a gurney.
Inside the building, the staff was in an uproar, everyone making sure their own butts were covered, especially the neglectful non-clinical staff members who were mostly incompetent political patronage hires.
That was my introduction to Neuroleptic Malignant Syndrome. Fortunately, that was also the only patient death during the year I worked at that hospital. The experience taught me to be on the lookout for NMS.
Emily Deans at Evolutionary Psychiatry wrote something I didn't know about the treatment of NMS:
(A rather unrelated aside - antipsychotic medications are well known for some pretty disturbing side effects. One of the scariest ones is called "neuroleptic malignant syndrome" where you get a high fever, stiffness, blood pressure spikes, and it can lead to kidney failure and death from muscle injury. One of the fastest treatments for NMS is electroshock therapy, believe it or not. What many people don't know is that schizophrenics institutionalized in the years prior to the invention of medication would suffer high fevers, stiffness, and death (it was called "malignant catatonia"). Now there is no question that the medicines cause NMS, but there is also an additional issue with the dopamine regulation in schizophrenia that could lead to autonomic dysfunction in a serious and fatal way. Just some food for thought.)