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Effects of Conventional Antipsychotic Drugs on the Extrapyramidal System by Dean A. Haycock, Ph.D.

The serious side effects of older antipsychotic medications such as Haldol and Thorazine can be traced to their effects in parts of the brain collectively called the extrapyramidal system. This interconnected system of sites in the brain influences motor or movement functions of the body. The side effects produced by the actions of antipsychotic drugs on these brain regions are referred to as extra-pyramidal signs (EPS). These are symptoms that are similar to Parkinson's disease; the only difference is that EPS disappear once the medication is stopped. There are three categories of EPS symptoms:

  • Akathisia is an intense feeling of restlessness and being unable to sit still or even stand still. Patients describe the feeling as wanting to climb the walls. A person ends up pacing the floors or fidgeting constantly. This tends to happen when the treatment is first started and gradually improves on its own or with dose adjustment. Sometimes it becomes necessary to treat it with another medication to allow the patient to become more comfortable and better able to tolerate the antipsychotic treatment.

  • Dystonia is an intense contraction or severe tensing up of a muscle that lasts for several minutes. While it is not a dangerous side effect, it may be very painful and scary, especially if it involves the muscles of the eye or the tongue. This may be an emergency only because it is severely uncomfortable, and it is frequently relieved with an injection.

  • Parkinsonism produces symptoms similar to those of Parkinson's disease. They can consist of tremors, most frequently involving the fingers or hands. Other symptoms are slow movements; decreased frequency of blinking, which makes the person appear as if she is staring into space; walking stiffly without swinging the arms; and a stooped posture.

    • The latter symptoms are responsible for some of the images that were associated with mental illness in the past. It has been called the zombie effect. It is important to realize that this is not a desirable outcome of treatment and your doctor should do all he can to get rid of these side effects and minimize their influence.

    Table 9-3: Medications for Treating Antipsychotic-Induced Extrapyra-midal Side Effects

    Side Effect

    Generic Medications

    Akathisia

    Benztropine, Trihexyphenidyl, Diazepam, Lorazepam, Propranolol

    Acute dystonia

    Benztropine, Biperiden, Diphen-hydramine, Trihexyphenidyl

    Parkinsonism

    Benztropine, Trihexyphe-nidyl, Amantadine

    Sources: The Essential Guide to Psychiatric Drugs and The Physician's Desk Reference

    <B>Tardive Dyskinesia</B></h2> <p>Another serious side effect involving movement is tardive dyski-nesia, which affects approximately 15 to 20 percent of patients taking older antipsychotic medications. The symptoms of this neurological condition include involuntary movements of the lips, tongue, hands, and feet. Sometimes the trunk and limbs are affected. It usually shows up after years of treatment with conventional antipsychotic medication, although it can appear sooner. If it is recognized early, tardive dyskinesia may disappear with a change of dose or medication. Sometimes the condition is mild and the patient is not bothered by it, but it can also become a permanent condition. Again, the key is for patients to have regular medical exams.</p> <!--/gc--> <div id="pagination"><ul><li class="prev"><a href="http://www.netplaces.com/schizophrenia/treating-schizophrenia-with-drugs/recognizing-the-side-effects.htm" title="Recognizing the Side Effects">Recognizing the Side Effects</a></li><li class="next"><a href="http://www.netplaces.com/schizophrenia/treating-schizophrenia-with-drugs/side-effects-of-atypical-antipsychotic-drugs.htm" title="Side Effects of Atypical Antipsychotic Drugs">Side Effects of Atypical Antipsychotic Drugs</a> </li></ul></div></div> <div id="coda"> <div id="rel"><div class="n5">Related Articles</div><ul> <li><a href="http://www.netplaces.com/schizophrenia/treating-schizophrenia-with-drugs/effects-of-conventional-antipsychotic-drugs-on-the-extrapyramidal-system.htm" zT="18/1YL/Zn"> Effects of Conventional Antipsychotic Drugs on the Extrapyramidal Syst... </a></li> <li><a href="http://www.netplaces.com/schizophrenia/treating-schizophrenia-with-drugs/is-there-a-right-medicine-for-everyone.htm" zT="18/1YL/Zn"> Is There a “Right” Medicine for Everyone? - Schizophrenia </a></li> <li><a href="http://mentalhealth.about.com/cs/psychopharmacology/a/antipsy_3.htm" zT="18/1YL/Zn"> Antipsychotic Medications </a></li> <li><a href="http://mentalhealth.about.com/cs/psychopharmacology/a/tardtive.htm" zT="18/1YL/Zn"> A movement disorder caused by older antipsychotic medications </a></li> <li><a href="http://bipolar.about.com/od/sideeffectslibrary/g/gl_tardivedysk.htm" zT="18/1YL/Zn"> Tardive Dyskinesia defined - serious side effects of certain medicatio... </a></li> </ul></div> <div id="sec"><div class="n5">Read More Treating Schizophrenia with Drugs</div><ul><ul class="col1"><li ><a href="http://www.netplaces.com/schizophrenia/treating-schizophrenia-with-drugs/finding-the-right-medication.htm">Finding the Right Medication</a></li> <li ><a href="http://www.netplaces.com/schizophrenia/treating-schizophrenia-with-drugs/how-do-antipsychotic-medications-work.htm">How Do Antipsychotic Medications Work?</a></li> <li ><a href="http://www.netplaces.com/schizophrenia/treating-schizophrenia-with-drugs/two-main-types-of-antipsychotic-drugs.htm">Two Main Types of Antipsychotic Drugs</a></li> <li ><a href="http://www.netplaces.com/schizophrenia/treating-schizophrenia-with-drugs/features-of-some-popular-antipsychotic-medications.htm">Features of Some Popular Antipsychotic Medications</a></li> <li ><a href="http://www.netplaces.com/schizophrenia/treating-schizophrenia-with-drugs/is-there-a-right-medicine-for-everyone.htm">Is There a “Right” Medicine for Everyone?</a></li> <li ><a href="http://www.netplaces.com/schizophrenia/treating-schizophrenia-with-drugs/realizing-the-benefits.htm">Realizing the Benefits</a></li> </ul><ul class="col2"><li ><a href="http://www.netplaces.com/schizophrenia/treating-schizophrenia-with-drugs/side-effects-of-first-generation-versus-second-generation-drugs.htm">Side Effects of First-Generation Versus Second-Generation Drugs</a></li> <li ><a href="http://www.netplaces.com/schizophrenia/treating-schizophrenia-with-drugs/recognizing-the-side-effects.htm">Recognizing the Side Effects</a></li> <li class="btO">Effects of Conventional Antipsychotic Drugs on the Extrapyramidal System</li> <li ><a href="http://www.netplaces.com/schizophrenia/treating-schizophrenia-with-drugs/side-effects-of-atypical-antipsychotic-drugs.htm">Side Effects of Atypical Antipsychotic Drugs</a></li> <li ><a href="http://www.netplaces.com/schizophrenia/treating-schizophrenia-with-drugs/precautions.htm">Precautions</a></li> <li ><a href="http://www.netplaces.com/schizophrenia/treating-schizophrenia-with-drugs/combination-treatments.htm">Combination Treatments</a></li> </ul></ul></div> </div> <script>if(zSbL<1)zSbL=3;zSB(2);zSbL=0</script> <script>document.write('<div id="coda" class="dcl"><p class="n5">Disclaimer</p><p>Information published in 2009. 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