EPSEs

Question 1

There are several types of Dystonia:-

Answer 1

Torticollis - cervical muscles spasms, resulting in a twisted posturing of the neck.
Trismus - contraction of the jaw musculature and can result in lockjaw.
Opisthotonus - arched posturing of the head, trunk, and extremities.
Laryngeal dystonia - difficulty in breathing
Oculogyric crises - involuntary contraction of one or more of the extraocular muscles, which may result in a fixed gaze with diplopia

Question 2

Which of the following drugs is an antihistamine used in the management of extrapyramidal side effects?

Answer 2

Diphenhydramine

Question 3

Risk factors of dystonia

Answer 3

• young males
• neuroleptic-naive
• high potency drugs (e.g. haloperidol

Question 4

Risk factors of pseudoparkinsonism

Answer 4

• elderly females

- those with pre-existing neuro damage (e.g. stroke)

Question 5

Risk factors of tardive dyskinesia

Answer 5

elderly women

• those with affective illness
• those who have had EPSE early on in treatment

Question 6

Treatment of dystonia

Answer 6

Anticholinergic drugs
Switching to alternative antipsychotic
Botulinum toxin
rTMS

Question 7

Treatment of akathisia

Answer 7

Reduce the dose
Switching to alternative antipsychotic
Propanolol
Clonazepam
Mirtazapine
Trazodone
Mianserin
Cyproheptadine
Diphenhydramine

Question 8

Treatments of tardive dyskinesia

Answer 8

Stop anticholinergic (if prescribed)
Reduce the dose
Switch to an atypical (clozapine and quetiapine have best evidence)
Tetrabenazine
Ginkgo biloba

Question 9

Dyskinesia

Answer 9

Dyskinesia is an abnormal, uncontrolled, involuntary movement.