Extrapyramidal syndromes caused by antipsychotics

Abstract

Introduction. Extrapyramidal syndromes are significant side effects of antipsychotic therapy due to their severity, frequent occurrence and complications. This paper gives a brief summary of the literature with the emphasis on epidemiology, etiology, diagnosis and differential diagnosis, as well as the treatment of extrapyramidal disorders induced by antipsychotics. Dystonia. Sustained muscle contractions cause twisting and repetitive movements or abnormal postures. It may appear either as an acute or delayed, i.e. tardive sign. The incidence of dystonia is 2-3% among the patients treated with antipsychotics, and 50% among the ones cured with conventional antipsychotics. Akathisia. The main feature of this curious adverse effect is the psychomotor restlessness and the inability to remain motionless. Although akathisia is not very frequent, its incidence and prevalence ranges from 5 to 50% among the treated patients. It is most probably a result of the blockage of dopaminergic receptors. Parkinsonism. The most frequent secondary Parkinsonism is the one caused by drugs. The characteristic parkinsonian signs regress 4 to 16 weeks after the discontinuation of antipsychotic therapy. In the era of atypical antipsychotics this adverse effect appears less frequently. Tardive dyskinesia. Involuntary choreatic movements may appear days and months after the introduction of continuous use of antipsychotics. The individual susceptibility may play the major role in the development of this side effect. Conclusion. Numerous studies have compared conventional and atypical antipsychotics as well as atypical ones with one another in order to decrease the risk of development of extrapyramical side effects as well as to prevent their occurrence and improve their treatment

Hubungan Pemberian Terapi Antipsikotik terhadap Kejadian Efek Samping Sindrom Ekstrapiramidal pada Pasien Rawat Jalan di Salah Satu Rumah Sakit di Bantul, Yogyakarta

“…(2012) menyatakan bahwa efek samping EPS umumnya muncul pada pasien skizofrenia setelah penggunaan terapi selama 4 minggu. 4 Antipsikotik generasi kedua (atipikal) sedikit atau bahkan tidak memiliki efek samping EPS pada dosis rendah. 5 Antipsikotik atipikal ini berhubungan dengan risiko peningkatan berat badan, gangguan kardiovaskular, dan diabetes melitus yang lebih besar dan risiko terjadinya gejala ekstrapiramidal yang lebih rendah bila dibandingkan dengan antipsikotik tipikal.…”

Second-Generation Antipsychotics and Extrapyramidal Adverse Effects

“…It occurs mostly within the first three months of treatment. Akathisia does not respond to anticholinergic medication, but antipsychotic dose reduction, liposoluble beta adrenergic blockers, and benzodiazepines have proved effective [ 24 , 25 ]. The rough estimation is that about 25% of patients treated with FGAs develop akathisia, but it is also common with SGAs.…”

Gambaran Penggunaan Obat Antipsikotik pada Pasien Skizofrenia di Puskesmas Kota Gorontalo

“…Risperidon memiliki efek hipersaliva yang lebih besar dibandingkan dengan obat antipsikotik atipikal lain seperti clozapine. Hal ini pula yang kemungkinan menyebabkan pasien mengalami hipersaliva saat menggunakan risperidone-haloperidol [32]. Dengan pemberian triheksilfenidil sebagai pencegahan, menurut para ahli adalah dengan tujuan untuk mencegah efek samping yang ditimbulkan obat-obat antipsikotik konvensional seperti gejala parknison, hipersalivasi, serta kekakuan otot-otot alat gerak yang biasa disebut sindrom ekstrapiramidal.…”