Atypical presentations of atypical antipsychotics (original) (raw)
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Extrapyramidal syndromes caused by antipsychotics
Medicinski pregled, 2012
Introduction. Extrapyramidal syndromes are significant side effects of antipsychotic therapy due to their severity, frequent occurrence and complications. This paper gives a brief summary of the literature with the emphasis on epidemiology, etiology, diagnosis and differential diagnosis, as well as the treatment of extrapyramidal disorders induced by antipsychotics. Dystonia. Sustained muscle contractions cause twisting and repetitive movements or abnormal postures. It may appear either as an acute or delayed, i.e. tardive sign. The incidence of dystonia is 2-3% among the patients treated with antipsychotics, and 50% among the ones cured with conventional antipsychotics. Akathisia. The main feature of this curious adverse effect is the psychomotor restlessness and the inability to remain motionless. Although akathisia is not very frequent, its incidence and prevalence ranges from 5 to 50% among the treated patients. It is most probably a result of the blockage of dopaminergic receptors. Parkinsonism. The most frequent secondary Parkinsonism is the one caused by drugs. The characteristic parkinsonian signs regress 4 to 16 weeks after the discontinuation of antipsychotic therapy. In the era of atypical antipsychotics this adverse effect appears less frequently. Tardive dyskinesia. Involuntary choreatic movements may appear days and months after the introduction of continuous use of antipsychotics. The individual susceptibility may play the major role in the development of this side effect. Conclusion. Numerous studies have compared conventional and atypical antipsychotics as well as atypical ones with one another in order to decrease the risk of development of extrapyramical side effects as well as to prevent their occurrence and improve their treatment.
Atypicality of Atypical Antipsychotics
The Primary Care Companion For CNS Disorders, 2005
To review the current definition of atypicality, discuss the unique features of each atypical antipsychotic, and determine whether the available drugs in this class really meet the classical definition of atypicality. Data Sources: A PubMed search was conducted to identify literature on the subject of this review, supported by additional articles based on the author's clinical knowledge and experience. Study Selection and Data Extraction: Relevant references were extracted and summarized in order to meet the objective of the article. Data Synthesis: Atypical antipsychotics are considered a major advance over conventional antipsychotics, primarily because they offer effective treatment alternatives that are relatively free of extrapyramidal symptoms. In fact, the term atypicality was originally used to describe antipsychotic agents with a minimal risk of causing extrapyramidal symptoms. However, over the years the definition has been modified such that there is currently no consensus on a true definition of atypicality for these agents. Each of the atypical antipsychotics (clozapine, risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole) commercially available in the United States is unique in terms of its pharmacologic profile, differing with respect to receptor-binding affinity, mechanism of action, and adverse events. Of the available atypical antipsychotics, clozapine and quetiapine have shown the lowest propensity to cause extrapyramidal symptoms. Although the risk of extrapyramidal symptoms is lower with risperidone and olanzapine than with conventional antipsychotics, risk increases with dose escalation. Data for ziprasidone indicate that the risk of extrapyramidal symptoms may be similar to that of risperidone and olanzapine. There is a concern of akathisia with aripiprazole; however, more experience with this agent is needed before definitive conclusions are made. Conclusion: If the definition of "atypical" antipsychotic is considered to be freedom from extrapyramidal symptoms, then, based on a comprehensive review of available data and clinical experience, clozapine and quetiapine appear to be the only true atypicals.
Recent management of extrapyramidal syndrome in antipsychotic use
Jurnal Kedokteran Syiah Kuala
Antipsychotic drugs are crucial for treating mental illnesses but can cause various side effects due to their non-selectivity and high affinity. A study has shown that the prevalence of extrapyramidal side effects among patients with schizophrenia spectrum disorder on antipsychotic medication was 42.6%, with specific side effects including tardive dyskinesia, parkinsonism, and akathisia. These symptoms can significantly impact individuals' quality of life, so effective management is crucial to minimize their impact. Recent advances in the management of EPS include the use of atypical/second-generation antipsychotics and anticholinergic medications. These have been shown to be effective in managing EPS and have a better safety profile than first-generation antipsychotics. Other important strategies for managing EPS include using lower doses of antipsychotics, combination therapy, anticholinergic drugs, and non-pharmacological interventions such as physical therapy, lifestyle modi...
Extrapyramidal Symptoms and Novel Antipsychotic Drugs
International Neuropsychiatric Disease Journal
One of the challenges of antipsychotic medication is the occurrence of Extrapyramidal Symptoms. These cannot be easily eliminated considering the pathophysiology of schizophrenia and the established mechanism of action of classical antipsychotics. The antipsychotics help improve symptoms of schizophrenia by binding to dopamine receptors in the central nervous system and blocking dopamine. This prevents the basal ganglia from getting enough dopamine. Many drugs used in the treatment of mental disorders such as the neuroleptics and antidepressants adversely affect extrapyramidal system function, resulting in symptoms such as tremors and muscle rigidity collectively known as extrapyramidal symptoms. Treatment generally involves lowering the dose or trying a different antipsychotic but drugs may also be used specifically to treat symptoms. This review examines the attempt to eliminate extrapyramidal symptoms by generations of antipsychotic medications and their comparative efficacy in t...
Archives of psychiatry research, 2023
Background: Antipsychotic medication for the treatment of schizophrenia spectrum disorders are associated with adverse effects with extrapyramidal side effects constituting one of the most notable effects associated with poor medication adherence and poor quality of life. Aims: The study aims to compare the prevalence of extrapyramidal side effects (EPSE), among patients with schizophrenia spectrum disorders on typical and atypical antipsychotic medications. The secondary aim is to determine the association of extra-pyramidal side effects with socio-clinical variables. Methodology: A cross-sectional hospital-based study with systematic random sampling recruitment of 340 participants and 303 completed the study. Variables with significant association on chi square analysis were subjected to logistic regression analysis. Results: The overall prevalence of extrapyramidal side effects among patients with schizophrenia spectrum disorder on antipsychotic medication was 42.6 %. The prevalence of tardive dyskinesia, parkinsonism and akathisia were 7.9 %, 38.6 and 3.6 %, respectively. The prevalence of extra-pyramidal side effects due to use of typical, atypical and combination drug was 44.4 %, 51.2 % and 34.5 %, respectively with haloperidol (59.4 %) and risperidone (71.4 %) having the greatest effect. Being elderly was associated with tardive dyskinesia, duration of treatment, severity of illness and type of illness with parkinsonism and severity of illness with akathisia. Conclusion: The findings of this study support the high prevalence of extrapyramidal side effects from either using typical and atypical antipsychotic medications. Therefore, Clinicians should discuss on these side effects and proffer possible solutions with their patients prior to commencement of antipsychotic medications in order to promote medication adherence.
Adverse Drug Reactions of Atypical Antipsychotics: A Review
Background: Adverse Drug Reactions (ADRs) as responses to drugs that are dangerous, unwanted, and occurring at doses typically used for prophylaxis, diagnosis, or modification of physiological function in humans. ADRs are a very important health problem to pay attention to. Currently, information on ADRs of atypical antipsychotics is lacking. Therefore, this literature study aims to summarize the adverse drug reactions (ADR) that occur due to the use of atypical antipsychotics and to examine their causality, severity, prevention, and predictability. Methods: The method used in the writing of this article is a literature study using computerized databases such as Science Direct, Pubmed, Semantic Scholar, and Google Scholar. The keywords used were "Adverse drug reactions" OR "ADRs" and "Atypical antipsychotics" OR "Second-generation antipsychotics". Results: The most common adverse drug reactions are weight gain, constipation, insomnia, dry mouth, tremor, sedation, hypersalivation, somnolence, extrapyramidal signs and symptoms (EPS), and headache. Assessment of causality by using the Naranjo's scale and the WHO assessment scale the results were "probable" followed by "possible" and "certain". Assessment of the severity by using the Hartwig and Siegel scale the results were "mild" followed by "moderate" and "severe". Prevention assessment of ADRs for atypical antipsychotics by using the Modified Schumock and Thornton scale the results were "probably preventable", followed by "not preventable" and "definitely preventable". The majority of ADRs from these atypical antipsychotics are predictable. Conclusion: The majority of ADRs of these atypical antipsychotics are predictable. However, to ensure patient safety, a large enough prospective study should be considered to clarify this issue.