Dystonia (Acute)
Prolonged involuntary contraction of muscles. More likely in first few
hours after giving anantipsychotic. Risk includes younger population,
males, High potency 1st generation antipsychotics.Located often in the
face and neck.
Treatment includes; IM anticholinergics (Benadryl), Benztropine, Valium.
Tardive Dyskinesia
results from the chronic blocking of the D2 receptor (antipsychotics
andmetoclopramide). The D2 receptors in the Nigrostriatal pathway
increase in number or upregulate
and this ultimately results in motor problems.
Abnormal chewing
Tongue protrusions
Grimacing
Lip smacking
Excessive eye blinking
Irregular movement of the head and trunk
Treatment includes; Prevention, Atypical antipsychotics associated with
lower risk, monitoring,
drug reduction or cessation, clozapine trial
NMS (Neuroleptic Malignant Syndrome)
A life threatening emergency that can occur any time on an
antipsychotic. More likely to occur
when first starting on an antipsychotic . Can also occur when there is an
abrupt reduction in dopamine activity.
Treatment includes; Intensive Care Unit admission, stopping the
antipsychotic, treating the fever,
Dantrolene, bromocriptine for muscle rigidity, IVF hydration
Parkinsonism (Neuroleptic Induced)
Motor deficits mimicking the symptoms observed in those with
Parkinson's disease. This is also a
result of D2 blockade in the caudate nigrostriatal dopamine neurons.
Elderly patients receiving
antipsychotics are at elevated risk.
Muscle stiffness
Cogwheel rigidity
Stooped posture
Pill rolling
Drooling
Bradykinesia
Treatment includes; Anticholinergics such as Benztropine and
Amantadine or antipsychotic reduction/discontinuation
Serotonin Syndrome
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