A Guide to the Extrapyramidal Side-Effects of Antipsychotic Drugs

Abstract

It is often implied that antipsychotic-induced extrapyramidal side-effects are irrelevant to modern psychiatric therapeutics, rendered historic by newer, better treatments. This myth arises from limited awareness of the depth and breadth of neurological disruption antipsychotics can mediate. This volume discusses the extensive clinical boundaries of acute dystonias, drug-induced parkinsonism, akathisia and tardive dyskinesia, providing demographic and epidemiological context while illustrating how prescribing choices impact powerfully on their development. This new edition has been thoroughly updated and rewritten to include recent data, expanded references and a new chapter on the concept of 'atypical' antipsychotics. Written in a light, engaging style, liberally illustrated with clinical examples, it also invites readers to consider ongoing controversies - subjective drug effects, the relationship between 'akathisia' and restless legs, the status of the concept of 'atypicality', and so on. Informative reading for trainees as well as established practitioners in the fields of psychiatry, neurology, primary care and geriatrics.

Conversions of Tricyclic Antidepressants and Antipsychotics with Selected P450s fromSorangium cellulosumSo ce56

“…Antipsychotic drugs and tricyclic antidepressants are used for the treatment of psychiatric disorders. In 1952, these psychotherapeutic drugs started with the discovery of chlorpromazine and since that time many drugs, mainly based on phenothiazine or iminodibenzyl, have been discovered and are used for psychiatric medication (Shen, 1999;Owens, 2014). The involvement of human liver P450s in the phase I biotransformation of these psychotherapeutics is well studied (Tanaka and Hisawa, 1999).…”

Predicting the incidence of antipsychotic-induced movement disorders in long-stay patients: A prospective study

“…Antipsychotic-induced movement disorders (Owens, 1999;Factor et al 2005) can be divided into acute syndromes, such as parkinsonism and akathisia, that occur within hours/days or weeks after initiating antipsychotic treatment or increasing the antipsychotic dose (or cessation of anticholinergics), and tardive syndromes, such as TD and tardive dystonia, that develop after months or years of treatment. Given that combinations of acute and chronic movement disorders occur in patients undergoing long-term treatment with antipsychotics, prediction models should include both syndromes, i.e., the four major types of movement disorders (TD, parkinsonism, akathisia and tardive dystonia).…”

An unexpected complication: acute dystonic reaction following use of ondansetron

“…However, it can pass through the blood-brain barrier and exert an adverse effect on the extrapyramidal system (6). Extrapyramidal system side effects occur by antagonizing dopamine receptors in basal ganglia (7). Acute dystonic reaction is one of these side effects and can be detected like regional tonus elevation, acute dyskinesia, ocululic crisis, torticollis, dysarthria, trismus, neuroleptic malignant syndrome, blepharospasm and parkinsonism (4,8).…”