From time to time, a player may encounter a crashed ship. If the crashed ship is larger or of a better Class or design than the current one, the player may wish to consider abandoning the current ship and taking over the crashed ship. However, the player can just purchase it for 0 credits and keep both. Photon cannon with fully upgraded power, accelerated fire, and cool down absolutely wrecks. The only issue is it's easy for a stray shot to hit an unintended target which could cause you some grief. I'm personally not a big fan of the phase beam so I don't use it. As for shields just go with all 3 shield upgrades. Not a lot of options there.

Aug 09, 2016 Healing – No Man’s Sky. With so many dangers in the world of No Man’s Sky in the form of animals, pirates, Sentinels, and just the environment itself, you’ll find yourself taking some serious damage every once in a while. Once your shields have given up and can’t take any more damage, the attacks will start taking chunks out of your health bar. Aug 29, 2013 now dmg on pulses and short range guns is nothing less than pathetic so much so that they need massive rof built in guns alone to achieve anything and you still need time when you press button nothing rly happens tiny red line appears on enemy ship shields.and there is range issue if you are using scorch you DMG and dps are taking a dive while.

Prim Care Companion J Clin Psychiatry. 2004; 6(5): 191–194.

PMID: 15514687

This article has been cited by other articles in PMC.

Abstract

In recent years, there has been an increased use of neuroleptic agents in the primary care setting. Neuroleptic malignant syndrome (NMS) is a rare complication of neuroleptic therapy that can be missed if not suspected. This manuscript reviews the diagnosis and management of NMS in the primary care setting. There is a lack of prospective data, and most of the information is obtained from case series. Physicians need to have a high index of suspicion with regard to excluding NMS in patients taking neuroleptics and presenting with hyperthermia.

The use of antipsychotic (neuroleptic) agents in the primary care setting is increasing for a variety of reasons, such as lack of access to psychiatric care; the advent of the atypical antipsychotics, which have a lower propensity for causing side effects; the increased use of the atypical antipsychotics to treat mood disorders; increased off-label use of atypical antipsychotics for anxiety disorders; and increased promotion by the pharmaceutical companies of the atypical agents in primary care and skilled nursing facilities.

Despite the fact that the atypical antipsychotics are safer and easier to use, side effects such as neuroleptic malignant syndrome (NMS) are still reported. Little is known about NMS in general (most data are from case studies rather than research), and still less is known about the nature of presentation of NMS with the atypical agents. Hence, we need to be vigilant and have a high index of suspicion when patients are taking neuroleptics. This article will provide an overview of diagnosis and management of NMS.

EPIDEMIOLOGY

Delay et al. were the first to describe neuroleptic malignant syndrome (NMS) in 1960. The incidence of NMS with conventional antipsychotics has been shown to be anywhere from 0.02% to 2.44%. Prospective studies in 2 psychiatric hospitals in the Boston area found an incidence of 0.07% to 0.9%. NMS has been reported among patients of all ages; however, most cases have occurred between the ages of 20 and 50 years, possibly due to high antipsychotic usage.

CAUSES

Although NMS is most commonly associated with antipsychotic usage, withdrawal of dopaminergic therapy such as levodopa and amantadine has also been reported to cause NMS. The syndrome has been reported with all antipsychotics, including atypicals such as clozapine, risperidone, quetiapine, and olanzapine. The use of metoclopramide and droperidol has also been implicated in the causation of NMS. Schizophrenia or affective disorders are the common diagnoses associated with NMS; however, NMS has also been reported with other conditions such as dementia, Parkinson's disease, Huntington's disease, and Wilson's disease in patients exposed to antipsychotics or dopamine-depleting agents or those who have had abrupt discontinuation of dopamine agonists.

DIAGNOSIS

One of the key interventions for decreasing the lethality in NMS is early detection. To make any early diagnosis, a high index of suspicion is required. Several diagnostic schemas have been proposed; however, there is no single set of criteria that is universally accepted. The reasons for these differences in diagnostic schemas are partly the lack of adequate prospective data on this illness and partly the fact that most of the information has been obtained from case studies. Nevertheless, there is agreement that elevated temperature (greater than or equal to 40°C, or 104°F); extrapyramidal symptoms, particularly lead-pipe rigidity; and autonomic instability (elevated or labile blood pressure, tachycardia, profuse diaphoresis, incontinence, and pallor) are considered cardinal features of NMS. Other findings that may help support the diagnosis are altered consciousness, tremor, mutism, leukocytosis, and elevated creatine phosphokinase (CPK) levels. It is important that other general medical conditions, as well as psychiatric disorders such as catatonia, are excluded prior to making the diagnosis of NMS.

The research criteria for NMS as listed in the DSM-IV¹⁶ require the presence of severe muscle rigidity and elevated temperature associated with neuroleptic medication use (Criterion A).¹⁶ In addition, the patient should have at least 2 other supportive symptoms such as diaphoresis, dysphagia, tremor, incontinence, changes in level of consciousness ranging from confusion to coma, mutism, tachycardia, elevated blood pressure, leukocytosis, or elevated CPK levels (Criterion B).¹⁶ General medical conditions and psychiatric disorders leading to NMS-like presentations should be excluded prior to making a diagnosis of NMS (Criteria C and D).¹⁶

In a study delineating symptoms of NMS, the syndrome was characterized by hyperpyrexia, muscular rigidity, alterations in the level of consciousness, autonomic dysfunction, and elevated CPK levels and white blood cell count. The alteration in consciousness runs the gamut from confusion to coma. The risk factors for NMS noted in the literature include dehydration, elevated temperature, rapid neuroleptic loading, alcoholism, previous brain injury, and treatment-resistant extrapyramidal symptoms (Table 1). NMS may manifest with varying severity.

Table 1.

Differential Diagnosis

The differential diagnosis of NMS (Table 2) includes malignant hyperthermia, which presents as clinically identical to NMS. It occurs following the administration of halogenated anesthetic agents and succinylcholine. The diagnosis of malignant hyperthermia can be made by exposing the biopsied muscle to halothane or caffeine, which results in a hypercontractile response not seen in NMS patients.
Table 2.
Differential Diagnosis of Neuroleptic Malignant Syndrome
Lethal catatonia begins with severe psychotic excitement, while NMS begins with rigidity. These 2 syndromes may be very difficult to distinguish. Neuroleptics should be stopped in both cases.
Heatstroke should also be considered in the differential diagnosis.
Central nervous system infective processes, which include meningitis, encephalitis, and neurosyphilis, should also be considered as likely causes.
Serotonin syndrome is an uncommon toxic, hyper-serotonergic state that needs a high index of suspicion so as to make the diagnosis. Serotonin syndrome is characterized by mental status changes, tachycardia, diaphoresis, labile blood pressure changes, shivering, tachypnea, mydriasis, and sialorrhea. Hyperthermia has been observed in 34% of NMS cases.²¹ Neurologic manifestations include tremor, myoclonus, tachycardia, hyperreflexia, ankle clonus, muscle rigidity, and incoordination. Leukocytosis, rhabdomyolysis, and elevated CPK levels are common.²¹
Allergic drug reactions may resemble NMS, as they also produce fever and autonomic instability.
Toxic encephalopathies such as tetanus, botulism, and anticholinergic delirium should also be considered when making the final diagnosis. The cerebral spinal fluid in NMS does not demonstrate the changes seen in central nervous system infections.

COMPLICATIONS

Estimates of mortality in NMS cases have ranged as high as 76%, although most reports put it between 10% and 20%, due primarily to complicatio

Nms Ship Taking Dmg On Fire