Antipsychotics: Motor Side Effects

  • Oliver Freudenreich
Part of the Current Clinical Psychiatry book series (CCPSY)


Antipsychotics can cause a wide range of motor side effects. This chapter reviews the clinical manifestations of the acute extrapyramidal syndromes (acute dystonic reaction, akathisia, Parkinsonism) and their treatments. Tardive dyskinesia (TD) as an important and irreversible movement disorder from chronic antipsychotic use is discussed, with emphasis on prevention and longitudinal assessment. Two new medications, valbenazine and deutetrabenazine, from the class of VMAT-2 inhibitors represent more effective and better-tolerated treatments for TD. Neuroleptic malignant syndrome (NMS) as a rare but potentially lethal complication of antipsychotics completes this chapter.


Extrapyramidal symptoms (EPS) Acute dystonic reaction (ADR) Akathisia Parkinsonism Tardive dyskinesia Prevention Assessment Treatment VMAT-2 inhibitors Neuroleptic-induced dysphoria Neuroleptic malignant syndrome (NMS) 


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Additional Resources

    Web Site

    1. – The Malignant Hyperthermia Association of the United States (MHAUS) also hosts the Neuroleptic Malignant Syndrome Information service (NMSIS) which offers many resources related to NMS, including a hotline for professionals.

    Book Chapter

    1. Freudenreich O, Flaherty AW. Patients with abnormal movements. In: Stern TA, Freudenreich O, Smith FA, Fricchione GL, Rosenbaum JF, editors. Massachusetts General Hospital handbook of general hospital psychiatry. 7th ed. Edinburgh: Elsevier; 2018. p. 231–29. – A more detailed book chapter that I wrote with a colleague from neurology about the assessment of patients with abnormal movements, including tremors and psychogenic movement disorder which I did not discuss here.Google Scholar


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Oliver Freudenreich
    • 1
  1. 1.Department of PsychiatryMassachusetts General HospitalBostonUSA

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