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Eps and NMS

This presentation outlines the types of extrapyramidal side effects that can occur with antipsychotic medications, including acute dystonia, parkinsonism, akathisia, and tardive dyskinesia. It also describes neuroleptic malignant syndrome, a psychiatric emergency caused by dopamine antagonists. Extrapyramidal symptoms are movement disorders caused by disruption of dopaminergic pathways and are most commonly caused by first-generation antipsychotics. Management involves reducing the offending medication, adding adjunctive therapies, or switching to atypical antipsychotics. Neuroleptic malignant syndrome presents with changes in mental status, parkinsonism, hyperthermia, and autonomic instability, and requires immediate medical attention.

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Naomi Oraeng
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32 views

Eps and NMS

This presentation outlines the types of extrapyramidal side effects that can occur with antipsychotic medications, including acute dystonia, parkinsonism, akathisia, and tardive dyskinesia. It also describes neuroleptic malignant syndrome, a psychiatric emergency caused by dopamine antagonists. Extrapyramidal symptoms are movement disorders caused by disruption of dopaminergic pathways and are most commonly caused by first-generation antipsychotics. Management involves reducing the offending medication, adding adjunctive therapies, or switching to atypical antipsychotics. Neuroleptic malignant syndrome presents with changes in mental status, parkinsonism, hyperthermia, and autonomic instability, and requires immediate medical attention.

Uploaded by

Naomi Oraeng
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as KEY, PDF, TXT or read online on Scribd
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EXTRAPYRAMIDAL SIDE EFFECTS OF

ANTIPSYCHOTICS INCLUDING THE


NEUROLEPTIC MALIGNANT SYNDROME
Presentation by Naomi Rose Oraeng MBBS IV
OBJECTIVES

By the end of this presentation you should be able to:

Outline the types of drugs known to cause EPS

Differentiate the types of etrapyramidal symptoms.

Summarize the treatment of EPS.

Describe and manage NMS


INTRODUCTION
. EPS are a collection of movement disorders that are typically due to disruption of dopaminergic
pathways in the basal ganglia.

. Caused by all antipsychotics that interact with the D2 receptors.

. EPS is thought to be involved with inhibition of the nigrostriatal dopaminergic pathways.

. The first-generation high potency antipsychotics haloperidol and fluphenazine neuroleptics, are
the most common medications associated with EPS.

. Other agents identified as causative of EPS, include low potency FGA; chlorpromazine &
thioridazine, SGA like risperidone & clozapine. Also antiemetics, lithium, SSRIs, stimulants and
TCAs.
EPS SUBTYPES

ADAPT: Acute Dystonia,


Akathisia, Parkinsonism &
Tardive dyskinesia
1. ACUTE DYSTONIA

. Painful and lasting muscle spasm and stiffness predominantly affecting the head, neck and
tongue. Geste antagoniste

. It may affect muscles in different body parts, including the back and extremities
(opisthotonus), neck (torticollis), jaw (trismus), eyes (oculogyric crisis), abdominal wall,
and pelvic muscles (tortipelvic crisis), and facial and tongue muscles (buccolingual crisis).

. Severe cases: laryngospasms.

. Managed with anticholinergics, antihistamines and benzodiazepines. Switching to a lower


risk drug and prophylaxis if needed. If severe then intubation.
2. PSEUDOPAKISONISM

. Present with cogwheel rigidity, masklike facies, psychomotor retardation, shuffling gait,
resting tremors and bradykinesia.

. First evidence may be diminished arm swing and decreased facial expressiveness

. ‘Pill rolling’ movemets and other tremors may be seen though they are less prominent in
psychotic induced Parkinsonism

. Management; dose reduction/discontinuation of the antipsychotics, administration of


medications used for Parkinson disease, including amantadine, antimuscarinic agents,
dopamine agonists, and levodopa.
3. AKATHISIA
. Characterized by a subjective feeling of internal restlessness and a compelling urge to move.

. Due to its often vague and non-specific presentation of nervousness and discomfort,
akathisia is often misdiagnosed as anxiety, restless leg syndrome, or agitation.

. This failure to correctly diagnose can be detrimental as the severity of akathisia is linked to
suicidal ideation, aggression, and violence.

. Management; strategies similar to managing dystonia are employed i.e stopping or reducing
the dosage of the offending medication, switching to an atypical antipsychotic if a typical
first-generation antipsychotic was the offending drug, and administering anti-muscarinic
agents.
4. TARDIVE DYSKINESIA
. Irreversible.

. Manifests as involuntary choreoathetoid movements affecting orofacial and tongue muscles,


and less commonly the truncal region and extremities.

. Even though symptoms are typically not painful, they may impede social interaction and
cause difficulty in chewing, swallowing, and talking

. It’s treated by withdrawal or dose reduction of the causative medication, switching to an


atypical antipsychotic, withdrawal of concurrent antimuscarinic medications, injection of
botulinum toxin for facial dyskinesia, benzodiazepines, and trial of dopamine-depleting
medications
NEUROLEPTIC MALIGNANT SYNDROME

.
PSYCHIATRIC EMERGENCY
.
Causative agents high potency FGS,
SGA,other dopamine antagonists.
.
risk factors
medication factors: sudden increase in
dosage, starting a new drug
patient factors: medical illness, dehydration,
exhaustion, poor nutrition, external heat
load, male, young adults
NMS CONTINUED
Typical presentation ;

Mental status changes (encephalopathy); delirium, confusion, stupor


Parkinsonism; muscle rigidity, akinesia, tremors
Hyperthermia: High-grade fever is common
Autonomic instability; tachycardia, dysrhythmias, tachypnea, diaphoresis, sialorrhea,urinary
incontinence
Dx: exclusion, keep a high index of suspicion in any pt on antipsychotics supportive laboratory
findings (e.g., elevated CK, Leukocytosis, transaminitis, myoglobinuria)
Mx; discontinue the suspected causative agent, supportive measures[heat dissipation, DVT
prophylaxis, bed @ 45degrees), ICU for unstable pt, psychiatrist for pharmacotherapy guidance and
electroconvulsive therapy for refractory pt’s.
REFERENCES

. Extrapyramidal Symptoms retrieved on 31/01/23 @ https://www.ncbi.nlm.nih.gov/books/NBK534115/

. Antipsychotics EPS retrieved on 30/01/23 @ https://www.amboss.com/us/knowledge/Antipsychotics/

. Neuroleptic malignant syndrome retrieved on 31/01/23 @ https://www.amboss.com/us/knowledge/Neuroleptic_malignant_syndrome/


THANK YOU 😊
Any questions?

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