Extrapyramidal side effects Flashcards
Prevalence of dystonia with typical antipsychotics
10%
Risk factors for developing dystonia on antipsychotics
Young males
Neuroleptic naive
High potency drugs e.g. haloperidol
Prevalence of pseudo-parkinsonism with typical antipsychotics
20%
Risk factors for developing pseudo-parkinsonism on antipsychotics
Elderly females
Pre-existing neurological damage e.g. stroke
Prevalence of akathisia with typical antipsychotics
25%
Prevalence of tardive dyskinesia with typical antipsychotics
5% per year of antipsychotic exposure
Risk factors for developing tardive dyskinesia with antipsychotic treatment
Elderly females
Affective illnesses
Those who have had EPSEs earlier on in treatment
Intellectual disability and brain damage
Time taken for dystonia to develop after starting antipsychotics
Minutes to hours
Time taken for pseudo-parkinsonism to develop after starting antipsychotics
Days to weeks - can also start days to weeks after an antipsychotic is increased
Time taken for akathisia to develop after starting antipsychotics
Hours to weeks
Time taken for tardive dyskinesia to develop after starting antipsychotics
Months to years - higher risk the longer the antipsychotics have been given for
Extrapyramidal side effect involving prolonged and unintentional muscular contractions
Dystonia
Extrapyramidal side effect involving tremor, rigidity, and bradykinesia
Pseudo-parkinsonism
Extrapyramidal side effect involving a subjective feeling of restlessness
Akathisia
Extrapyramidal side effect involving involuntary repetitive movements, often of the face, tongue, and lips
Tardive dyskinesia
Extrapyramidal side effect most resistant to treatment
Akathisia
Antipsychotic which carries the highest risk of extrapyramidal side effects
Haloperidol
Antipsychotic which carries the lowest risk of extrapyramidal side effects
Clozapine
Treatments for dystonia
Anticholinergic drugs
Switch to alternative antipsychotic
Botulinum toxin
Treatments for pseudo-parkinsonism
Reduce dose
Switch to alternative antipsychotic
Anticholinergic drugs
Treatments for akathisia
Reduce dose Switch to alternative antipsychotic Propanolol Mirtazapine Anticholinergic drugs Cyproheptadine Benzodiazepines Clonidine
Treatments for tardive dyskinesia
Reduce dose Switch to alternative antipsychotic Stop any anticholinergic medications already prescribed Tetrabenazine Ginkgo biloba
Anticholinergics used for extrapyramidal side effects
Procyclidine
Trihexyphenidyl
Orphenadrine
Benztropine
Antihistamine used for extrapyramidal side effects due to its anticholinergic properties
Diphenhydramine
Most serious extrapyramidal side effect
Laryngeal dystonia
Type of dystonia where there are muscle spasms resulting in a twisted posture of the neck
Torticollis
Type of dystonia where the jaw muscles are contracted
Trismus
Type of dystonia where there is an arched posturing of the head, trunk, and extremities
Opisthotonus
Type of dystonia where there is difficulty breathing
Laryngeal dystonia
Type of dystonia where there is involuntary contraction of one or more of the extraocular muscles leading to a fixed gaze +/- diplopia
Oculogyric crisis
Extrapyramidal side effect which may be a feature of schizophrenia rather than just a treatment side effect
Tardive dyskinesia
Benzodiazepines recommended for treating akathisia
Diazepam
Clonazepam
Factors that increase symptoms of tardive dyskinesia
Emotional arousal
Distraction
Factors that decrease symptoms of tardive dyskinesia
Relaxation
Using the muscles for voluntary tasks
Effect of sleep on symptoms of tardive dyskinesia
Symptoms disappear
Only licensed treatment for tardive dyskinesia in the UK
Tetrabenazine
Percentage of cases of tardive dyskinesia which are reversible on reducing or stopping the antipsychotic
50-55%
Dystonia occurring after months to years of antipsychotic treatment
Tardive dystonia
Treatment options for tardive dystonia
Botulinum toxin
ECT
Deep brain stimulation
Risk factors for developing akathisia
Older women Iron deficiency Negative symptoms Affective features Cognitive impairment
Vitamin used as an add on treatment for tardive dyskinesia
Pyridoxine (vitamin B6)
Most well established risk factor for developing tardive dyskinesia
Older age