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*'''Muscle contractions''' - Uncontrolled and severe contractions can occur in | '''Extrapyramidal symptoms''' (EPS), also known as '''extrapyramidal side effects''' (EPSE), are drug-induced movement disorders that include acute and tardive/chronic symptoms. They are mainly caused by the blockade of dopamine at dopaminergic receptors. | ||
*''' | ==Symptoms== | ||
*'''Muscle contractions''' - Uncontrolled and severe contractions can occur in the head, neck, and limbs and may cause a stiff tongue, arched back, or twisted neck. Another sign is that the patient/victim finds it very difficult to talk, sometimes having the mouth "locked open." | |||
*Continuous '''[[muscle spasms]]''' | |||
*'''Restlessness''' - This can include nervous energy such as pacing or tapping one's foot. | *'''Restlessness''' - This can include nervous energy such as pacing or tapping one's foot. | ||
*'''Decreased bodily movement''' | *'''Decreased bodily movement''' | ||
*'''[[Tremors]]''' | *'''[[Tremors]]''' | ||
*'''Stiff posture''' - This can include the lack of arm movement when walking. | *'''Stiff posture''' - This can include the lack of arm movement when walking. | ||
*Tardive dyskinesia (irregular, jerky movements).<ref>Pierre, J. M. (2005). Extrapyramidal Symptoms with Atypical Antipsychotics. Drug Safety, 28(3), 191–208. https://doi.org/10.2165/00002018-200528030-00002</ref> | *Tardive or acute dyskinesia (irregular, jerky movements).<ref>Pierre, J. M. (2005). Extrapyramidal Symptoms with Atypical Antipsychotics. Drug Safety, 28(3), 191–208. https://doi.org/10.2165/00002018-200528030-00002</ref> | ||
*'''Uncontrolled movements''' - This may include uncontrolled movements of the tongue, jaw, lips, fingers, toes, or face, such as pursing one's lips, chewing, frequently blinking one's eyes, nodding one's head, or pelvic thrusting. | **'''Uncontrolled movements''' - This may include uncontrolled movements of the tongue, jaw, lips, fingers, toes, or face, such as pursing one's lips, chewing, frequently blinking one's eyes, nodding one's head, or pelvic thrusting. | ||
*'''[[Irregular breathing]]''' - This may include grunts, gasping, or | *'''[[Irregular breathing]]''' or '''[[Respiratory depression|respiratory arrest]]''' - This may include grunts, gasping, sighing, or, in severe cases, the complete absence of breathing. | ||
*'''Weak voice''' | *'''Weak voice''' or '''thick speech''' - The muscles in the mouth and throat as well as the face are likely too contracted and weakened to properly form sound. | ||
*'''[[Salivation]]''' | *'''[[Salivation]]''' | ||
*'''Lack of facial expression''' | *'''Lack of facial expression''' | ||
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==Treatment== | ==Treatment== | ||
[[File:Akineton Advertisement, 1966.jpg|400px|thumbnail|right|Advertisement for Akineton (biperiden).]] | |||
[[Acetylcholine|Anticholinergic]] drugs are used to control neuroleptic-induced EPS, although akathisia may require beta blockers or even [[benzodiazepines]]. If the EPS are induced by an [[antipsychotic]], EPS may be reduced by dose [[Tapering|titration]] or by switching to an atypical [[antipsychotic]], such as aripiprazole, ziprasidone, [[quetiapine]], olanzapine, [[risperidone]], or clozapine. | [[Acetylcholine|Anticholinergic]] drugs are used to control neuroleptic-induced EPS, although akathisia may require beta blockers or even [[benzodiazepines]]. If the EPS are induced by an [[antipsychotic]], EPS may be reduced by dose [[Tapering|titration]] or by switching to an atypical [[antipsychotic]], such as aripiprazole, ziprasidone, [[quetiapine]], olanzapine, [[risperidone]], or clozapine. | ||
Commonly used medications for EPS are [[acetylcholine|anticholinergic]] agents such as benztropine (Cogentin), [[diphenhydramine]] (Benadryl), and trihexyphenidyl (Artane). Another common course of treatment includes [[dopamine]] [[agonist]] agents such as pramipexole. These medications reverse the symptoms of extrapyramidal side effects caused by [[antipsychotics]] or other drugs that either directly or indirectly inhibit [[Dopamine|dopaminergic]] neurotransmission. | Commonly used medications for EPS are [[acetylcholine|anticholinergic]] agents such as biperiden (Akineton), benztropine (Cogentin), [[diphenhydramine]] (Benadryl), and trihexyphenidyl (Artane). Another common course of treatment includes [[dopamine]] [[agonist]] agents such as pramipexole and ropinirole. These medications reverse the symptoms of extrapyramidal side effects caused by [[antipsychotics]] or other drugs that either directly or indirectly inhibit [[Dopamine|dopaminergic]] neurotransmission. | ||
==See also== | ==See also== | ||
*[[Antipsychotics]] | *[[Antipsychotics]] | ||
**[[Haloperidol]], one of the most common agents associated with EPS | |||
**[[Risperidone]], another agent known to induce EPS | |||
*[[Responsible drug use]] | *[[Responsible drug use]] | ||
*[[Dopamine]] | *[[Dopamine]] | ||
==Citations== | ==Citations== | ||
Revision as of 17:33, 23 September 2017
Extrapyramidal symptoms (EPS), also known as extrapyramidal side effects (EPSE), are drug-induced movement disorders that include acute and tardive/chronic symptoms. They are mainly caused by the blockade of dopamine at dopaminergic receptors.
Symptoms
- Muscle contractions - Uncontrolled and severe contractions can occur in the head, neck, and limbs and may cause a stiff tongue, arched back, or twisted neck. Another sign is that the patient/victim finds it very difficult to talk, sometimes having the mouth "locked open."
- Continuous muscle spasms
- Restlessness - This can include nervous energy such as pacing or tapping one's foot.
- Decreased bodily movement
- Tremors
- Stiff posture - This can include the lack of arm movement when walking.
- Tardive or acute dyskinesia (irregular, jerky movements).[1]
- Uncontrolled movements - This may include uncontrolled movements of the tongue, jaw, lips, fingers, toes, or face, such as pursing one's lips, chewing, frequently blinking one's eyes, nodding one's head, or pelvic thrusting.
- Irregular breathing or respiratory arrest - This may include grunts, gasping, sighing, or, in severe cases, the complete absence of breathing.
- Weak voice or thick speech - The muscles in the mouth and throat as well as the face are likely too contracted and weakened to properly form sound.
- Salivation
- Lack of facial expression
Causes
Extrapyramidal symptoms are most commonly caused by typical antipsychotic drugs that antagonize dopamine D2 receptors. The most common typical antipsychotics associated with EPS are haloperidol and fluphenazine.[2]
Other anti-dopaminergic drugs, like the antiemetic metoclopramide, can also result in extrapyramidal side effects.[3]
Short and long-term use of antidepressants such as selective serotonin reuptake inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitors (SNRI), and norepinephrine-dopamine reuptake inhibitors (NDRI) have also resulted in extrapyramidal symptoms. Specifically, duloxetine, sertraline, escitalopram, fluoxetine, and bupropion have been linked to the induction of extrapyramidal symptoms.[4]
Treatment
Anticholinergic drugs are used to control neuroleptic-induced EPS, although akathisia may require beta blockers or even benzodiazepines. If the EPS are induced by an antipsychotic, EPS may be reduced by dose titration or by switching to an atypical antipsychotic, such as aripiprazole, ziprasidone, quetiapine, olanzapine, risperidone, or clozapine.
Commonly used medications for EPS are anticholinergic agents such as biperiden (Akineton), benztropine (Cogentin), diphenhydramine (Benadryl), and trihexyphenidyl (Artane). Another common course of treatment includes dopamine agonist agents such as pramipexole and ropinirole. These medications reverse the symptoms of extrapyramidal side effects caused by antipsychotics or other drugs that either directly or indirectly inhibit dopaminergic neurotransmission.
See also
- Antipsychotics
- Haloperidol, one of the most common agents associated with EPS
- Risperidone, another agent known to induce EPS
Citations
- ↑ Pierre, J. M. (2005). Extrapyramidal Symptoms with Atypical Antipsychotics. Drug Safety, 28(3), 191–208. https://doi.org/10.2165/00002018-200528030-00002
- ↑ Note, I. (2009). Extrapyramidal adverse effects Extrapyramidal adverse effects. Biomed Res Int., 2014, 30–32. https://doi.org/10.1155/2014/656370
- ↑ Moos, D. D., & Hansen, D. J. (2008). Metoclopramide and Extrapyramidal Symptoms: A Case Report. Journal of Perianesthesia Nursing, 23(5), 292–299. https://doi.org/10.1016/j.jopan.2008.07.006
- ↑ Madhusoodanan, S., Alexeenko, L., Sanders, R., & Brenner, R. (2010). Extrapyramidal symptoms associated with antidepressants--a review of the literature and an analysis of spontaneous reports. Annals of Clinical Psychiatry : Official Journal of the American Academy of Clinical Psychiatrists, 22(3), 148–56. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20680187