Lecture Notes: Extrapyramidal Symptoms from Antipsychotics

Introduction

• Antipsychotics can cause extrapyramidal symptoms (EPS).
• EPS includes several types of movement disorders.

Types of Extrapyramidal Symptoms

1. Acute Dystonia

• Description: Painful or prolonged muscle contractions (e.g., trismus, torticollis).
• Onset: Occurs hours after taking medication.
• Treatment:
  • Diphenhydramine
  • Anticholinergics like benzotropine

2. Dyskinesia

• Description: Pseudo-Parkinsonism features such as shuffling gait, cogwheel rigidity.
• Onset: Occurs days after taking medication.
• Treatment:
  • Dopamine agonist like amantadine
  • Anticholinergics

3. Akathisia

• Description: Restlessness which may appear as distress.
• Onset: Can start weeks after taking medication.
• Treatment:
  • Lowering the medication dose
  • Adding a beta blocker like propranolol

4. Tardive Dyskinesia

• Description: Repetitive, involuntary, painless oral-facial movements (e.g., teeth grinding, lip smacking).
• Onset: Occurs months after taking medication.
• Treatment:
  • Discontinuing the medication or lowering the dose
  • Note: Adding anticholinergics may worsen symptoms initially.

5. Neuroleptic Malignant Syndrome

• Description: Severe condition with altered mental status, muscle rigidity, and autonomic instability due to dopamine inhibition.
• Onset: Can occur anytime, usually in the first three months of treatment.
• Treatment:
  • Immediate cessation of the antipsychotic medication
  • Requires ICU care and administration of dopamine agonists

Conclusion

• Be aware of these side effects when prescribing antipsychotic medications.
• Understanding EPS can help manage and mitigate these side effects effectively.