Extrapyramidal reaction: Difference between revisions
ClaireLewis (talk | contribs) No edit summary |
|||
| Line 22: | Line 22: | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
===Movement Disorders and Other Causes of Abnormal Muscle Contractions=== | |||
*[[Neuroleptic malignant syndrome]] | *[[Neuroleptic malignant syndrome]] | ||
*[[Serotonin syndrome]] | *[[Serotonin syndrome]] | ||
| Line 31: | Line 32: | ||
*[[Phencyclidine toxicity]] | *[[Phencyclidine toxicity]] | ||
*[[Anti-NMDA receptor encephalitis]] | *[[Anti-NMDA receptor encephalitis]] | ||
*[[Extrapyramidal reaction]] | |||
*[[Neuroleptic malignant syndrome]] | |||
*[[Serotonin syndrome]] | |||
[[Huntington disease]] | |||
[[Sydenham chorea]] | |||
[[Wilson disease ]] | |||
*[[CVA]] | |||
*[[Schizophrenia]] | |||
*[[Psychotic agitation]] | |||
*Dementia | |||
**Lewy body dementia | |||
**Vascular dementia | |||
**Frontotemporal dementia | |||
*Idiopathic movement disorder | |||
==Evaluation== | ==Evaluation== | ||
Revision as of 13:36, 14 November 2020
Background
- Adverse effect of antipsychotics.
- More common with high-potency typical antipsychotics, but can also occur with atypical agents
- Due to antagonism of dopamine-2 receptors in basal ganglia
Clinical Features
- Early-onset syndromes
- hours to days after drug initiation
- reversible
- Acute dystonic reaction
- involuntary, uncoordinated skelatal muscle contraction
- Akathisia
- subjective sensation of intense motor restlessness
- may be misdiagnosed as manifestation of psychiatric disease
- Parkinsonism
- onset weeks to months after starting medication
- similar presentation to Parkinson's disease (e.g. cogwheel rigidity, pill-rolling tremor, shuffling gait, bradykinesia)
- Tardive dyskinesia
- usually irreversible or only partially reversible
- associated with prolonged use of antipsychotics
- stereotyped, repetitive facial movements (e.g. tongue protrusion, grimacing, lip smacking)
Differential Diagnosis
Movement Disorders and Other Causes of Abnormal Muscle Contractions
- Neuroleptic malignant syndrome
- Serotonin syndrome
- Hypocalcemia
- Strychnine toxicity
- Acute tetanus
- Parkinson's disease
- Mono amine oxidase inhibitor toxicity
- Phencyclidine toxicity
- Anti-NMDA receptor encephalitis
- Extrapyramidal reaction
- Neuroleptic malignant syndrome
- Serotonin syndrome
Huntington disease Sydenham chorea Wilson disease
- CVA
- Schizophrenia
- Psychotic agitation
- Dementia
- Lewy body dementia
- Vascular dementia
- Frontotemporal dementia
- Idiopathic movement disorder
Evaluation
Management
- Stop or reduce offending agent
- may need to discuss with psychiatrist to prescribe new medication or for recs on taper
- Acute dystonia, akasthisia, parkinsonism
- diphenhydramine 25-50mg PO or IV
- OR benztropine 1-2mg PO or IV/IM
- continue PO antihistamines for 2 days after stopping antipsychotic
- +/- benzodiazepines
- Tardive dyskinesia
- may only be partially reversible, so minimize occurrence, stop or reduce offending agent promptly
- Do NOT give anticholinergics, will exacerbate symptoms