<s>[INST] Hi.My patient is a 18 y/o girl , a known case of bipolar disorder.she have developed psychosis Since 5 days ago(acutly and without any precipitants)  Now she is admitted , cpk is rising from 500(yesterday) to 19000(today morning) and 56000 now(afternoon).LDH is 2000.HB is 11.4 wbc:8800 U/A: 1+ blood with 8-10 RBC, BUN,cr,Na,K :normalShe is oriented,with a low grade fever without rigidity, without pain, normal neurological exam,All drugs are holded(previous drugs:lithium and risperidone from 1yr ago till today morning)WOULD U PLZ HELP ME TO DIAGNOSE AND MANAGE THE PROBLEM [/INST] Hello, She is developing NMS most probably but appears to have better prognosis as she is hospitalized and Chat Doctor.  It is good she has no rigidity and some tests are normal, she is oriented and neurologically normal. The only management presently is supportive and involves controlling fever, maintain fluid and electrolyte balance and prevention of kidney functioning. Let her be hospitalized, under 24hrs surveillance till her CPK and Blood counts improve. She cannot be managed at home presently. The treating team is doing good work, I think you should trust them. Wish you good luck. </s>