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News & Perspective > Current Medical Research and Opinion
Antipsychotics The Future of Schizophrenia Treatment
George Beaumont
DISCLOSURES | Curr Med Res Opin. 2000;16(1)
0
6. 5/16/2017 Antipsychotics
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EPS
As already indicated, the most important sideeffects of typical antipsychotics are those involving the extrapyramidal system. There are four
types of EPS, namely parkinsonian symptoms, dystonia, akathisia and tardive dyskinesia (TD). Druginduced parkinsonism typically
manifests in tremor, rigidity and bradykinesia, and usually occurs within days or weeks of the initiation of therapy. Although these symptoms
commonly remit upon withdrawal of treatment, they can be treated with anticholinergic drugs. The routine administration of anticholinergic
drugs is not advised since they may worsen TD, and drugs such as procyclidine and benzhexol have, unfortunately, become substances of
abuse by some patients.
The classical signs of acute dystonia (occurring within a few days of commencing treatment) are sustained muscular conditions that produce
abnormal postures (opisthotonos, torticollis), difficulty in swallowing and oculogyric crisis[10]. The chronic form is more difficult to recognise,
often coexisting with TD with a mixture of choreoathetoid and dystonic features. Akathisia is a particularly distressing aspect of the
extrapyramidal syndrome, often starting within a few days of the initiation of treatment. Patients experience a sense of inner restlessness,
mental unease, unrest or dysphonia. Restless movements, such as rocking from foot to foot, walking on the spot, shuffling and swinging one
leg on the other while sitting, may be associated with the subjective experience. Rapid pacing up and down is characteristic of severe cases;
such patients may find it impossible to sit, lie or stand in any one position for more than a few minutes[11]. Akathisia is very common, and
some estimates suggest that it can occur in as many as 49% of patients treated with typical antipsychotics[11]. It can become chronic,
affecting about a third of patients receiving maintenance neuroleptic treatment. Unfortunately, akathisia is sometimes misdiagnosed as
psychotic agitation, with a consequent increase in the dose of antipsychotic, which only leads to further deterioration.
TD is a late onset adverse effect of standard antipsychotic therapy. It is typified by involuntary hyperkinetic, choreoathetoid movements of
the orofacial, limb and truncal regions, and occurs in 1520% of predisposed patients. Risk factors for TD include age, previous druginduced
parkinsonism, affective disorder, diabetes mellitus and female gender (especially after the menopause)[10]. Dopamine D 2 receptor
hypersensitivity has been postulated as the underlying pathophysiology of TD.
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Curr Med Res Opin. 2000;16(1) © 2000 Librapharm Limited
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