221:
rating scales frequently used for such assessment and are not weighted for diagnostic purposes; these scales can help clinicians weigh the benefit/expected benefit of a medication against the degree of distress which the side effects are causing the patient, aiding in the decision to maintain, reduce, or discontinue the causative medication(s).
220:
Since it is difficult to measure extrapyramidal symptoms, rating scales are commonly used to assess the severity of movement disorders. The
Simpson-Angus Scale (SAS), Barnes Akathisia Rating Scale (BARS), Abnormal Involuntary Movement Scale (AIMS), and Extrapyramidal Symptom Rating Scale (ESRS) are
308:
Medications are used to reverse the symptoms of extrapyramidal side effects caused by antipsychotics or other drugs, by either directly or indirectly increasing dopaminergic neurotransmission. The treatment varies by the type of the EPS, but may involve
641:; Richard S.E. Keefe; Sonia M. Davis; Clarence E. Davis; Barry D. Lebowitz; Joanne Severe; John K. Hsiao & for the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Investigators (September 22, 2005).
136:; of the 213 (14.6%) subjects that dropped out of one of the largest clinical trials of antipsychotics (the CATIE trial , which included 1460 randomized subjects), 58 (27.2%) of those discontinuations were due to EPS.
1099:
212:
Other causes of extrapyramidal symptoms can include brain damage and meningitis. However, the term "extrapyramidal symptoms" generally refers to medication-induced causes in the field of psychiatry.
411:, are more likely to cause akathisia compared to other second-generation antipsychotics. If akathisia occurs, switching to an antipsychotic with a lower risk of akathisia may improve symptoms.
439:
Medication interventions are generally reserved for cases in which withdrawing the medication that caused the pseudoparkinsonism is either ineffective or infeasible.
247:: A feeling of internal motor restlessness that can present as tension, nervousness, or anxiety. Clinical manifestations include pacing and an inability to sit still.
846:
Ori Scott; Simona Hasal & Helly R. Goez (November 2013) . "Basal
Ganglia Injury With Extrapyramidal Presentation: A Complication of Meningococcal Meningitis".
299:: involuntary muscle movements in the lower face and distal extremities; this can be a chronic condition associated with long-term use of antipsychotics.
289:
leads to dysregulation of the extrapyramidal system. Since this system regulates posture and skeletal muscle tone, a result is the characteristic
1135:
395:
medications are used to reverse acute dystonia. If the symptoms are particularly severe, the anticholinergic medication may be administered by
177:
181:
165:. Atypical antipsychotics have lower D2 receptor affinity or higher serotonin 5-HT2A receptor affinity which lead to lower rates of EPS.
447:
is sometimes used as well. It is rare for dopamine agonists to be used for antipsychotic-induced EPS, as they may exacerbate psychosis.
799:
173:
475:
Extrapyramidal symptoms (also called extrapyramidal side effects) get their name because they are symptoms of disorders in the
984:"The Incidence of Akathisia in the Treatment of Schizophrenia with Aripiprazole, Asenapine and Lurasidone: A Meta-Analysis"
800:"Extrapyramidal symptoms associated with antidepressants—A review of the literature and an analysis of spontaneous reports"
443:
medications are sometimes used to treat pseudoparkinsonism, but they can be difficult to tolerate when given chronically.
456:
376:
pathway, which means they are associated with fewer extrapyramidal side-effects than "conventional" antipsychotics (
455:
When other measures fail or are not feasible, medications are used to treat tardive dyskinesia. These include the
233:: painful, muscular spasms of neck, jaw, back, extremities, eyes, throat, and tongue; highest risk in young men.
492:
372:. These medications possess an additional mode of action that is believed to mitigate their effect on the
239:
is a kind of acute dystonic reaction that involves the prolonged involuntary upward deviation of the eyes.
479:, which regulates posture and skeletal muscle tone. This is in contrast to symptoms originating from the
172:, can also result in extrapyramidal side effects. Short and long-term use of antidepressants such as
760:
Moos, DD.; Hansen, DJ. (October 2008). "Metoclopramide and
Extrapyramidal Symptoms: A Case Report".
633:
1130:
396:
940:
345:
278:
154:
822:
476:
341:
282:
150:
69:
589:"Extrapyramidal symptoms with atypical antipsychotics: incidence, prevention and management"
419:) are frequently used to treat akathisia. Other medications that are sometimes used include
128:(irregular, jerky movements). Extrapyramidal symptoms are a reason why subjects drop out of
634:
113:
8:
1103:
681:
407:
Certain second-generation antipsychotics, such as lurasidone and the partial D2-agonist
340:, EPS may be reduced by decreasing the dose of the antipsychotic or by switching from a
1140:
1108:
1057:
1033:"Revisiting Antipsychotic-induced Akathisia: Current Issues and Prospective Challenges"
1032:
1031:
Salem, Haitham; Nagpal, Caesa; Pigott, Teresa; Teixeira, Antonio Lucio (15 June 2017).
1008:
983:
943:"Extrapyramidal motor side-effects of first- and second-generation antipsychotic drugs"
871:
710:
683:
616:
551:
518:
333:
are not used, as they may worsen psychotic symptoms to those taking neuroleptic drugs.
296:
250:
125:
61:
1048:
999:
1062:
1013:
964:
863:
814:
777:
715:
664:
608:
604:
556:
538:
236:
97:
93:
40:
982:
E. Thomas, Jennifer; Caballero, Joshua; A. Harrington, Catherine (13 October 2015).
875:
620:
65:
1052:
1044:
1003:
995:
954:
855:
769:
742:
705:
695:
654:
600:
546:
530:
480:
464:
330:
286:
262:
89:
497:
440:
392:
326:
322:
310:
73:
773:
428:
377:
169:
129:
959:
942:
941:
Michael J. Peluso; ShĂ´n W. Lewis; Thomas R. E. Barnes; Peter B. Jones (2012).
642:
534:
1124:
859:
682:
Nevena Divac; Milica
Prostran; Igor Jakovcevski & Natasa Cerovac (2014).
643:"Effectiveness of Antipsychotic Drugs in Patients with Chronic Schizophrenia"
638:
542:
460:
373:
337:
133:
637:; T. Scott Stroup; Joseph P. McEvoy; Marvin S. Swartz; Robert A. Rosenheck;
1066:
1017:
968:
867:
818:
781:
719:
668:
612:
560:
412:
408:
349:
314:
290:
258:
254:
193:
162:
109:
746:
700:
659:
424:
416:
381:
365:
353:
318:
270:
158:
117:
1091:
444:
361:
357:
285:
and not the extrapyramidal system, loss of dopaminergic neurons in the
274:
197:
189:
185:
77:
733:
Correll C (2014). "Mechanism of Action of
Antipsychotic Medications".
431:. Anticholinergic medications are not helpful for treating akathisia.
684:"Second-Generation Antipsychotics and Extrapyramidal Adverse Effects"
420:
369:
244:
201:
105:
45:
797:
588:
230:
101:
845:
981:
121:
16:
Symptoms associated with the extrapyramidal system of the brain
153:
drugs that antagonize dopamine D2 receptors. The most common
798:
Madhusoodanan S, Alexeenko L, Sanders R, Brenner R (2010).
266:
1030:
35:
extrapyramidal side effects (EPSE) (when caused by drugs)
916:
1081:
759:
149:
Extrapyramidal symptoms are most commonly caused by
168:Other anti-dopaminergic drugs, like the antiemetic
1122:
184:(NDRI) have also resulted in EPS. Specifically,
900:Kaufman's Clinical Neurology for Psychiatrists
893:
891:
889:
887:
885:
104:(continuous spasms and muscle contractions),
793:
791:
582:
580:
578:
576:
574:
572:
570:
517:Akagi, Hiroko; Kumar, T Manoj (2002-06-22).
178:serotonin-norepinephrine reuptake inhibitors
975:
898:"Involuntary Movement Disorders (Ch. 18)".
882:
182:norepinephrine-dopamine reuptake inhibitors
1024:
586:
516:
204:have been linked to the induction of EPS.
1056:
1007:
958:
788:
732:
709:
699:
658:
567:
550:
277:; greater risk in the elderly). Although
207:
174:selective serotonin reuptake inhibitors
80:or other drugs, they are also known as
1123:
917:"Be Drug Wise: Psychotherapeutic Meds"
108:(may manifest as motor restlessness),
1136:Extrapyramidal and movement disorders
911:
909:
450:
434:
921:Educational Global Technologies, Inc
76:. When such symptoms are caused by
13:
906:
14:
1152:
1077:
1049:10.2174/1570159X14666161208153644
1000:10.2174/1570159X13666150115220221
947:The British Journal of Psychiatry
762:Journal of PeriAnesthesia Nursing
519:"Akathisia: overlooked at a cost"
457:vesicular monoamine transporter 2
399:to rapidly reverse the dystonia.
224:
605:10.2165/00002018-200528030-00002
112:characteristic symptoms such as
934:
33:extrapyramidal manifestations;
839:
753:
726:
675:
627:
510:
493:Neuroleptic malignant syndrome
329:. Certain medications such as
281:is primarily a disease of the
144:
1:
902:(8th ed.). Elsevier Inc.
807:Annals of Clinical Psychiatry
688:BioMed Research International
503:
336:If the EPS are induced by an
523:BMJ: British Medical Journal
402:
303:
215:
7:
774:10.1016/j.jopan.2008.07.006
486:
387:
82:extrapyramidal side effects
10:
1157:
470:
344:to an (or to a different)
96:(long-term). They include
1085:
1037:Current Neuropharmacology
988:Current Neuropharmacology
960:10.1192/bjp.bp.111.101485
535:10.1136/bmj.324.7352.1506
139:
39:
29:
24:
860:10.1177/0883073812457463
231:Acute dystonic reactions
157:associated with EPS are
120:(slowness of movement),
397:injection into a muscle
88:). The symptoms can be
54:Extrapyramidal symptoms
25:Extrapyramidal symptoms
346:atypical antipsychotic
208:Non-medication-related
155:typical antipsychotics
747:10.4088/jcp.13078tx4c
477:extrapyramidal system
342:typical antipsychotic
283:nigrostriatal pathway
151:typical antipsychotic
70:extrapyramidal system
660:10.1056/NEJMoa051688
635:Jeffrey A. Lieberman
98:movement dysfunction
68:associated with the
701:10.1155/2014/656370
587:Pierre, JM (2005).
529:(7352): 1506–1507.
279:Parkinson's disease
269:, stooped posture,
451:Tardive dyskinesia
435:Pseudoparkinsonism
297:Tardive dyskinesia
251:Pseudoparkinsonism
126:tardive dyskinesia
1118:
1117:
854:(11): 1489–1492.
735:J Clin Psychiatry
653:(12): 1209–1223.
331:dopamine agonists
261:, tremor, masked
237:Oculogyric crisis
51:
50:
19:Medical condition
1148:
1083:
1082:
1071:
1070:
1060:
1028:
1022:
1021:
1011:
979:
973:
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962:
938:
932:
931:
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927:
913:
904:
903:
895:
880:
879:
843:
837:
836:
834:
833:
827:
821:. Archived from
804:
795:
786:
785:
757:
751:
750:
730:
724:
723:
713:
703:
679:
673:
672:
662:
639:Diana O. Perkins
631:
625:
624:
584:
565:
564:
554:
514:
481:pyramidal tracts
465:deutetrabenazine
287:substantia nigra
92:(short-term) or
22:
21:
1156:
1155:
1151:
1150:
1149:
1147:
1146:
1145:
1121:
1120:
1119:
1114:
1113:
1094:
1080:
1075:
1074:
1029:
1025:
980:
976:
939:
935:
925:
923:
915:
914:
907:
897:
896:
883:
844:
840:
831:
829:
825:
802:
796:
789:
758:
754:
731:
727:
680:
676:
632:
628:
585:
568:
515:
511:
506:
498:Rabbit syndrome
489:
473:
453:
441:Anticholinergic
437:
429:benzodiazepines
405:
393:Anticholinergic
390:
327:trihexyphenidyl
323:diphenhydramine
313:agents such as
311:anticholinergic
306:
293:of Parkinson's.
253:: drug-induced
227:
218:
210:
147:
142:
130:clinical trials
74:cerebral cortex
72:of the brain's
34:
20:
17:
12:
11:
5:
1154:
1144:
1143:
1138:
1133:
1131:Antipsychotics
1116:
1115:
1112:
1111:
1095:
1090:
1089:
1087:
1086:Classification
1079:
1078:External links
1076:
1073:
1072:
1043:(5): 789–798.
1023:
994:(5): 681–691.
974:
933:
905:
881:
848:J Child Neurol
838:
813:(3): 148–156.
787:
768:(5): 292–299.
752:
725:
674:
626:
599:(3): 191–208.
566:
508:
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505:
502:
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500:
495:
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472:
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436:
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378:chlorpromazine
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248:
242:
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226:
225:Classification
223:
217:
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170:metoclopramide
146:
143:
141:
138:
134:antipsychotics
66:archetypically
49:
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43:
37:
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31:
27:
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953:(5): 387–92.
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828:on 2013-11-27
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461:tetrabenazine
458:
448:
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442:
432:
430:
426:
422:
418:
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413:Beta blockers
410:
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374:nigrostriatal
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367:
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339:
338:antipsychotic
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28:
23:
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1040:
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1026:
991:
987:
977:
950:
946:
936:
926:10 September
924:. Retrieved
920:
899:
851:
847:
841:
830:. Retrieved
823:the original
810:
806:
765:
761:
755:
738:
734:
728:
691:
687:
677:
650:
647:N Engl J Med
646:
629:
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526:
522:
512:
474:
454:
438:
409:aripiprazole
406:
391:
350:aripiprazole
335:
315:procyclidine
307:
291:bradykinesia
265:, shuffling
259:bradykinesia
255:parkinsonism
219:
211:
194:escitalopram
180:(SNRI), and
167:
163:fluphenazine
148:
118:bradykinesia
110:parkinsonism
85:
81:
57:
53:
52:
694:: 6 pages.
593:Drug Safety
459:inhibitors
425:mirtazapine
417:propranolol
382:haloperidol
366:risperidone
354:ziprasidone
319:benztropine
271:sialorrhoea
257:(rigidity,
159:haloperidol
145:Medications
78:medications
30:Other names
1125:Categories
832:2016-05-03
741:(9): e23.
504:References
445:Amantadine
427:, or even
362:olanzapine
358:quetiapine
348:, such as
275:seborrhoea
198:fluoxetine
190:sertraline
186:duloxetine
1141:Syndromes
543:0959-8138
421:clonidine
403:Akathisia
370:clozapine
304:Treatment
245:Akathisia
216:Diagnosis
202:bupropion
106:akathisia
64:that are
46:Neurology
41:Specialty
1067:27928948
1018:26467415
969:22442101
876:30536341
868:22965562
819:20680187
782:18926476
720:24995318
669:16172203
621:41268164
613:15733025
561:12077042
487:See also
388:Dystonia
384:, etc.)
176:(SSRI),
114:rigidity
102:dystonia
100:such as
62:symptoms
1058:5771055
1009:4761637
711:4065707
552:1123446
471:History
94:chronic
1109:333.90
1065:
1055:
1016:
1006:
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874:
866:
817:
780:
718:
708:
667:
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611:
559:
549:
541:
415:(like
325:, and
273:, and
263:facies
200:, and
140:Causes
124:, and
122:tremor
60:) are
872:S2CID
826:(PDF)
803:(PDF)
617:S2CID
368:, or
90:acute
1104:9-CM
1063:PMID
1014:PMID
965:PMID
928:2020
864:PMID
815:PMID
778:PMID
716:PMID
692:2014
665:PMID
609:PMID
557:PMID
539:ISSN
463:and
267:gait
161:and
86:EPSE
1100:ICD
1053:PMC
1045:doi
1004:PMC
996:doi
955:doi
951:200
856:doi
770:doi
743:doi
706:PMC
696:doi
655:doi
651:353
601:doi
547:PMC
531:doi
527:324
132:of
58:EPS
1127::
1107::
1061:.
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1039:.
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1012:.
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963:.
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852:28
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