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Chapter 34. Drugs to Treat Extrapyramidal Side Effects

Joseph K. Stanilla, M.D.; George M. Simpson, M.D.
DOI: 10.1176/appi.books.9781585623860.430901

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Excerpt

The discovery of the therapeutic properties of chlorpromazine (Delay and Deniker 1952; Laborit et al. 1952) was soon followed by the description of its tendency to produce extrapyramidal side effects (EPS) that were indistinguishable from classical Parkinson's syndrome. A debate soon arose regarding the relationship between EPS and therapeutic efficacy. Flügel (1953) suggested that a therapeutic response from chlorpromazine required the development of EPS. Haase (1954) postulated that the neuroleptic dose that produced minimal subclinical rigidity and hypokinesis (i.e., the "neuroleptic threshold") was the minimal neuroleptic dose necessary for therapeutic antipsychotic effect and that it was manifested by micrographic handwriting changes. Other investigators also reported that EPS were necessary for therapeutic efficacy (see Denham and Carrick 1960; Karn and Kasper 1959).

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Table Reference Number
TABLE 34–1. Pharmacological agents for the treatment of neuroleptic-induced parkinsonism and acute dystonic reactions
Table Reference Number
TABLE 34–2. Beta-blockers investigated in the treatment of akathisia
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TABLE 34–3. Treatment of parkinsonism
Table Reference Number
TABLE 34–4. Risk factors leading to acute dystonic reactions

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Sample questions:
1.
Various types of extrapyramidal side effects (EPS) associated with the use of antipsychotic medications have been described. One type consists of both an objective restless movement and a subjective feeling of restlessness that the patient experiences as the need to move. What is this type of EPS called?
2.
Drugs used to treat extrapyramidal side effects (EPS) include anticholinergic, antihistaminic, and dopaminergic agents. All of the following are anticholinergic medications except
3.
Which of the following is a side effect of anticholinergic medications?
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