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Antipsychotics: Motor Side Effects

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

Abstract

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.

Keywords

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. https://www.mhause.org – 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

    Articles

    1. Gurrera RJ, Caroff SN, Cohen A, Carroll BT, DeRoos F, Francis A, et al. An international consensus study of neuroleptic malignant syndrome diagnostic criteria using the Delphi method. J Clin Psychiatry. 2011;72:1222–8. – Consensus criteria using the Delphi method (a RAND cooperation-developed method to establish expert consensus) for a diagnosis of NMS.PubMedCrossRefPubMedCentralGoogle Scholar
    2. Munetz MR, Benjamin S. How to examine patients using the Abnormal Involuntary Movement Scale. Hosp Community Psychiatry. 1988;39:1172–7. – The standard reference, with clear instructions about how to correctly use the AIMS.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

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

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