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Questions and Answers
Extrapyramidal symptoms (EPS) are less likely to occur with high doses of low-potency FGAs.
True
Patients who mismanage substances are at a decreased risk of developing akathisia.
False
Cognitive impairment and poor long-term psychosocial functioning may be linked to Parkinsonian symptoms in EPS.
True
The prevalence of akathisia among never-medicated first-episode patients with schizophrenia is reported to be 8%.
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A study found no difference in the occurrence of EPS between first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs).
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Dystonia describes a condition primarily affecting older individuals with low-potency antipsychotic medications.
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The prevalence of akathisia is consistently low across all populations, regardless of the type of antipsychotic medication used.
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Tardive dyskinesia involves involuntary facial movements but does not affect eating, speaking, or breathing.
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The Simpson-Angus EPS Rating Scale is used to assess the severity of tardive dyskinesia.
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Akathisia may present with symptoms like foot stamping and constant leg movements.
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The prevalence of tardive dyskinesia increases with age and higher doses of antipsychotics.
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The prevalence of pseudoparkinsonism is higher in elderly men and those with no prior neurological conditions.
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Acute dystonia typically develops within weeks after starting antipsychotic medication.
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Pseudoparkinsonism symptoms may include bradykinesia, tremors, and rigidity.
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Tardive dyskinesia symptoms may emerge immediately after medication is initiated.
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Anticholinergic medications are typically recommended for long-term management of movement disorders.
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Chronic akathisia can remain persistent for several weeks after the medication dose increase.
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Reducing the antipsychotic dose is a strategy to manage movement disorders.
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Symptoms of acute akathisia appear only within hours of starting medication.
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The reversibility of tardive dyskinesia symptoms is uncertain and may depend on the patient's age.
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Study Notes
Extrapyramidal Symptoms (EPS)
- EPS are movement disorders that can occur as a side effect of antipsychotic medications.
- They tend to be dose-related, meaning higher doses of medication are more likely to cause EPS.
- High-potency typical antipsychotics (FGAs) are more likely to cause EPS than other antipsychotics, including atypical antipsychotics (SGAs).
- Clozapine, olanzapine, quetiapine, and aripiprazole are less likely to cause EPS, but once present, the symptoms can be persistent.
- Individuals may be genetically predisposed to developing EPS.
- Similar movement disorders can occur in people with schizophrenia who have never taken antipsychotic medication.
- EPS can be confused with symptoms of depression or negative symptoms of schizophrenia.
- Substance misuse, especially alcohol consumption, can increase the risk of developing EPS.
Types of EPS
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Dystonia: Uncontrolled muscle spasms in any part of the body.
- Occurs in approximately 10% of individuals taking antipsychotics, but more common in young males and those taking high-potency FGAs.
- Can be acute (occurs within hours) or tardive (develops over months or years).
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Pseudoparkinsonism: Symptoms similar to Parkinson's disease, including tremors, rigidity, and slow movement (bradykinesia).
- Occurs in approximately 20% of individuals taking antipsychotics.
- More common in elderly women and those with pre-existing neurological damage, like stroke.
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Akathisia: Subjective feeling of restlessness and an urge to move.
- Occurs in approximately 25% of individuals taking antipsychotics.
- Can range from mild to severe.
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Tardive Dyskinesia: Abnormal involuntary movements of the face, mouth, tongue, and limbs.
- Occurs in approximately 5% of patients per year of antipsychotic exposure.
- More common with older age, longer duration of antipsychotic use, higher doses, and affective illnesses.
- Individuals with early EPS are more prone to developing TD.
Treatment Strategies for EPS
- Reducing the Antipsychotic Dose: Reducing the dose of the antipsychotic medication can help to alleviate EPS symptoms.
- Switching to a Different Antipsychotic: Switching to a different antipsychotic medication with a lower propensity for EPS can be helpful.
- Anticholinergic Medications: These medications can help manage some of the symptoms of dystonia and pseudoparkinsonism but are not typically recommended for long-term use.
- Other Medications: Other medications, such as propranolol, clonazepam, and benzodiazepines, may also be used to manage EPS symptoms.
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Description
Test your knowledge on extrapyramidal symptoms (EPS) and their relation to antipsychotic medications. This quiz covers the types of EPS, risk factors, and distinguishing characteristics. Learn about how genetics and substance misuse can influence the occurrence of these movement disorders.
