Extrapyramidal side effects

Question 1

Types of EPSE

Answer 1

1. Acute dystonic
2. Parkinsonism
3. Akathisia
4. Neuroleptic malignant syndrome
5. Tardive dyskinesia

Question 2

Dystonia: onset, risk group, presentation, treatment

Answer 2

Acute 90 days
Young, males, high dose
Sustained abnormal posture, torsions, twisting, contraction of muscles groups, muscle spasms, occulogyric crisis, laryngospasm
Treatment with benztropine

Question 3

Akathisia: onset, risk group, presentation, treatment

Answer 3

Acute and tardive
Elderly females
Motor restlessness, distressing, +risk of suicide and poor adherence
Treatment with propranolol

Question 4

Pseudoparkinsonism: onset, risk group, presentation, treatment

Answer 4

Acute
Elderly female
Tremor, rigid, bradykinesia
Treatment with benztropine

Question 5

Tardive dyskinesia: onset, risk group, presentation, treatment

Answer 5

Irreversible
Purposeless, constant movements, involving facial and mouth musculature, less commonly the limbs->grimacing, tongue smacking, rapid eye movement
Treatment: no good treatment, discontinue drug/reduce dose->best option is to switch to clozapine

Question 6

Features of NMS

Answer 6

FARM
Fever
Autonomic changes
Rigidity of muscles
Mental status changes

Question 7

Comparing NMS and SS

Answer 7

SS is twitching, restless, flushed, sweaty, VD, abdominal pain

NMS is severe global rigidity, pallor and no GI syptoms