Hi, I'm Katie Arison here with another Hippo Short. We all know that antipsychotics can cause extrapyramidal symptoms, but at times I forget what actually is underneath that umbrella. So let's talk about it.
The first is acute dystonia. That's a painful or prolonged muscle contraction like trismus or torticollis. It can happen hours after the patient takes the medication. We treat it with diphenhydramine or an anticholinergic like benzotropine. The next is dyskinesia, which is pseudo-Parkinsonianism, which is like shuffling gait or cogwheel rigidity.
This can occur days after taking a medication. We treat this with a dopamine agonist like a mantidine or an anticholinergic. The next is akesthesia, which is restlessness that looks like distress.
The patient's actually not in distress, but just appears so with how restless they are. This can start weeks after taking the medication. We treat this by trying to lower the dose to see if that helps or adding a beta blocker like propranolol.
The one they're probably most familiar with. And the one that's scariest really is charted out dyskinesia because it could be irreversible. This is those repetitive, involuntary, painless oral facial movements like teeth grinding or lip smacking. This can occur months after taking the medication. So we can treat this by discontinuing that particular med or lowering the dose.
But remember, adding an anticholinergic initially may worsen the symptoms. And then the granddaddy of them all, the one that can cause death, is neuroleptic malignant syndrome. This causes ultra-mental status and muscle rigidity and autonomic instability because of dopamine inhibition. It can happen any time on these medications, but usually in the first three months.
And the treatment for this is immediately stopping the med. These patients need the ICU care and they need a dopamine agonist. So next time you write for a medication like this, remember the side effects from it. And you can hopefully remember all the things that kind of fall under the umbrella of extra pyramidal symptoms.