Recognition and management of acute neuroleptic-induced extrapyramidal motor and mental syndromes.
After nearly 50 years of therapeutic application of neuroleptics, diagnosis and classification of neuroleptic-induced extrapyramidal syndromes still concentrate on their "neurological" (motor) aspects. Psychiatric (mental) aspects are in general - if at all - regarded as "secondary" to motor symptoms. Psychiatric side effects of neuroleptics (including psychotic exacerbations during neuroleptic treatment) have, however, anecdotally been reported since 1954 but never developed into a systematic classification. Accordingly, psychiatric manifestations of extrapyramidal side effects frequently are overlooked, misdiagnosed as psychotic deteriorations and treated by increased dosing of neuroleptics instead anticholinergics, which in addition are falsely suspected of bearing a high addictive potential and the risk of development of tardive dyskinesia. It is suggested that neuroleptic-induced basal ganglia dysfunction results in motor as well as mental extrapyramidal side effects, whose recognition and management is essential to achieve better tolerability of and thereby compliance with neuroleptic treatment.
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BKH Taufkirchen, Germany.
D000208:Acute Disease; D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects*; D001479:Basal Ganglia / Q000503:physiopathology; D001480:Basal Ganglia Diseases / Q000139:chemically induced* / Q000188:drug therapy / Q000503:physiopathology; D018680:Cholinergic Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004421:Dystonia / Q000139:chemically induced / Q000175:diagnosis; D005260:Female; D006801:Humans; D001523:Mental Disorders / Q000188:drug therapy*; D008875:Middle Aged; D011595:Psychomotor Agitation / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D011605:Psychoses, Substance-Induced / Q000175:diagnosis / Q000209:etiology*
D014150:Antipsychotic Agents; D018680:Cholinergic Antagonists