Talk:Extrapyramidal symptoms: Difference between revisions

(9 intermediate revisions by 2 users not shown)

Line 1:

[[File:Four types of EPS.png|275px|thumbnail|right|An image that quickly summarizes the four types of extrapyramidal symptoms with illustrations.]]

'''Extrapyramidal symptoms''' (EPS), also known as '''extrapyramidal side effects''' (EPSE), are drug-induced movement disorders that include acute and tardive/chronic symptoms. They are mainly caused by the blockade of dopamine at dopaminergic receptors.

==Types and their symptoms==

===Acute dystonia===

[[File:Medication-induced dystonia.JPG|275px|thumbnail|right|A patient experiencing acute dystonia caused by a dopamine-blocking medication.]]

Acute dystonia is a painful and often severe type of extrapyramidal symptoms that occurs shortly (within less than a day){{citation needed}} after the administration of an [[dopamine|antidopaminergic]] agent.

[[Muscle spasms|Continuous muscle contractions]] can occur in the head, neck, and limbs and may cause a stiff tongue, arched back, or twisted neck. Dystonia also includes a lack of ability to move muscle and low muscle tone.

~~'''Extrapyramidal symptoms''' (EPS)~~, ~~also known as '''extrapyramidal side effects''' (EPSE)~~, are ~~drug~~-~~induced movement disorders that include acute~~ and ~~tardive/chronic symptoms~~. ~~They are mainly caused by~~ the ~~blockade of dopamine at dopaminergic receptors~~.

Treatment of acute dystonia is often an anticholinergic agent and/or a benzodiazepine.{{citation needed}}

==~~Symptoms~~==

===Akathisia===

Akathisia is characterized by restlessness, a need to move, constant sitting down and standing up, pacing, etc. Treatments for akathisia are anticholinergics, beta blockers, or [[benzodiazepines]]. Akathisia typically develops some time during a medication regimen{{citation needed}}

===Psuedoparkinsonism===

Psuedoparkinsonism occurs often further than akathisia.{{citation needed}} It is often noticed by seeing:

*tremoring hands in a "pill-rolling" pose,

*a stooped posture,

*slowed movements,

*shuffling, small steps,

and others. Others also include that when the person turns, they must do so very slowly and sometimes cannot change positions, such as standing to sitting, without a support.

===Tardive dyskinesia===

This disorder develops over long periods of time{{citation needed}} and is noticed by these signs: involuntary chewing, lip smacking or sucking, twitching, and/or involuntary movements of the limbs that are often jerky. It is treated by putting the patient on a dopaminergic medication regimen, such as using valbenzaine, tetrabenazine, ropinirole, or pramipexole.

*'''Muscle contractions''' - Uncontrolled and severe contractions can occur in the head, neck, and limbs and may cause a stiff tongue, arched back, or twisted neck. Another sign is that the patient/victim finds it very difficult to talk, sometimes having the mouth "locked open."

*Continuous '''[[muscle spasms]]'''

*'''Restlessness''' - This can include nervous energy such as pacing or tapping one's foot.

*'''Decreased bodily movement'''

*'''[[Tremors]]'''

*'''Stiff posture''' - This can include the lack of arm movement when walking.

*Tardive or acute dyskinesia (irregular, jerky movements).<ref>Pierre, J. M. (2005). Extrapyramidal Symptoms with Atypical Antipsychotics. Drug Safety, 28(3), 191–208. https://doi.org/10.2165/00002018-200528030-00002</ref>

**'''Uncontrolled movements''' - This may include uncontrolled movements of the tongue, jaw, lips, fingers, toes, or face, such as pursing one's lips, chewing, frequently blinking one's eyes, nodding one's head, or pelvic thrusting.

*'''[[Irregular breathing]]''' or '''[[Respiratory depression|respiratory arrest]]''' - This may include grunts, gasping, sighing, or, in severe cases, the complete absence of breathing.

*'''Weak voice''' or '''thick speech''' - The muscles in the mouth and throat as well as the face are likely too contracted and weakened to properly form sound.

*'''[[Salivation]]'''

*'''Lack of facial expression'''

==Causes==

Extrapyramidal symptoms are most commonly caused by typical antipsychotic drugs that [[Antagonist|antagonize]] [[dopamine]] D2 [[receptors]].

The most common typical [[antipsychotics]] associated with EPS are [[haloperidol]] and fluphenazine.<ref>Note, I. (2009). ~~Extrapyramidal adverse effects~~ Extrapyramidal adverse effects. Biomed Res Int., 2014, 30–32. https://doi.org/10.1155/2014/656370</ref>

The most common typical [[antipsychotics]] associated with EPS are [[haloperidol]] and fluphenazine.<ref>Note, I. (2009). Extrapyramidal adverse effects. Biomed Res Int., 2014, 30–32. https://doi.org/10.1155/2014/656370</ref>

Other ~~anti-dopaminergic~~ drugs, like the [[Nausea suppression|antiemetic]] metoclopramide, can also result in extrapyramidal side effects.<ref>Moos, D. D., & Hansen, D. J. (2008). Metoclopramide and Extrapyramidal Symptoms: A Case Report. Journal of Perianesthesia Nursing, 23(5), 292–299. https://doi.org/10.1016/j.jopan.2008.07.006</ref>

Other antidopaminergic drugs, like the [[Nausea suppression|antiemetic]] metoclopramide, can also result in extrapyramidal side effects.<ref>Moos, D. D., & Hansen, D. J. (2008). Metoclopramide and Extrapyramidal Symptoms: A Case Report. Journal of Perianesthesia Nursing, 23(5), 292–299. https://doi.org/10.1016/j.jopan.2008.07.006</ref>

Short and long-term use of antidepressants such as selective serotonin reuptake inhibitors ([[SSRI]]), serotonin-norepinephrine reuptake inhibitors (SNRI), and norepinephrine-dopamine reuptake inhibitors (NDRI) ~~have~~ also resulted in extrapyramidal symptoms. Specifically, duloxetine, sertraline, escitalopram, fluoxetine, and bupropion have been linked to the induction of extrapyramidal symptoms.<ref>Madhusoodanan, S., Alexeenko, L., Sanders, R., & Brenner, R. (2010). Extrapyramidal symptoms associated with antidepressants--a review of the literature and an analysis of spontaneous reports. Annals of Clinical Psychiatry : Official Journal of the American Academy of Clinical Psychiatrists, 22(3), 148–56. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20680187</ref>

Short and long-term use of antidepressants, such as selective serotonin reuptake inhibitors ([[SSRI]]), serotonin-norepinephrine reuptake inhibitors (SNRI), and norepinephrine-dopamine reuptake inhibitors (NDRI) has also resulted in extrapyramidal symptoms. Specifically, duloxetine, sertraline, escitalopram, fluoxetine, and bupropion have been linked to the induction of extrapyramidal symptoms.<ref>Madhusoodanan, S., Alexeenko, L., Sanders, R., & Brenner, R. (2010). Extrapyramidal symptoms associated with antidepressants--a review of the literature and an analysis of spontaneous reports. Annals of Clinical Psychiatry : Official Journal of the American Academy of Clinical Psychiatrists, 22(3), 148–56. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20680187</ref>

==Treatment==

[[File:Akineton Advertisement, 1966.jpg|400px|thumbnail|right|Advertisement for Akineton (biperiden).]]

[[File:Akineton Advertisement, 1966.jpg|400px|thumbnail|right|Advertisement for Akineton (biperiden), used for pseudoparkinsonism.]]

[[Acetylcholine|Anticholinergic]] drugs are used to control neuroleptic-induced EPS, although akathisia may require beta blockers or even [[benzodiazepines]]. If the EPS are induced by an [[antipsychotic]], EPS may be reduced by dose [[Tapering|titration]] or by switching to an atypical [[antipsychotic]], such as aripiprazole, ziprasidone, [[quetiapine]], olanzapine, [[risperidone]], or clozapine.

Commonly used medications for EPS are [[acetylcholine|anticholinergic]] agents such as ~~biperiden~~ (~~Akineton~~), ~~benztropine~~ (~~Cogentin~~), [[diphenhydramine]] (Benadryl), and trihexyphenidyl (Artane). Another common course of treatment includes [[dopamine]] [[agonist]] agents such as pramipexole and ropinirole. These medications reverse the symptoms of extrapyramidal side effects caused by [[antipsychotics]] or other drugs that either directly or indirectly inhibit [[Dopamine|dopaminergic]] neurotransmission.

Commonly used medications for EPS are [[acetylcholine|anticholinergic]] agents such as benztropine (Cogentin), biperiden (Akineton), [[diphenhydramine]] (Benadryl), and trihexyphenidyl (Artane). Another common course of treatment includes [[dopamine]] [[agonist]] agents, such as pramipexole and ropinirole. These medications reverse the symptoms of extrapyramidal side effects caused by [[antipsychotics]] or other drugs that either directly or indirectly inhibit [[Dopamine|dopaminergic]] neurotransmission.

==Literature==

==External links==

[https://en.wikipedia.org/wiki/Extrapyramidal_symptoms Extrapyramidal symptoms (Wikipedia)]

==See also==

Line 35:

Line 47:

**[[Haloperidol]], one of the most common agents associated with EPS

**[[Risperidone]], another agent known to induce EPS

*[[Diphenhydramine]], an agent sometimes used to treat EPS

*[[Responsible drug use]]

*[[Dopamine]]

==~~Citations~~==

==References==

[[Category:Approval]]

@@ Line 1: / Line 1: @@
+[[File:Four types of EPS.png|275px|thumbnail|right|An image that quickly summarizes the four types of extrapyramidal symptoms with illustrations.]]
+'''Extrapyramidal symptoms''' (EPS), also known as '''extrapyramidal side effects''' (EPSE), are drug-induced movement disorders that include acute and tardive/chronic symptoms. They are mainly caused by the blockade of dopamine at dopaminergic receptors.
+==Types and their symptoms==
+===Acute dystonia===
+[[File:Medication-induced dystonia.JPG|275px|thumbnail|right|A patient experiencing acute dystonia caused by a dopamine-blocking medication.]]
+Acute dystonia is a painful and often severe type of extrapyramidal symptoms that occurs shortly (within less than a day){{citation needed}} after the administration of an [[dopamine|antidopaminergic]] agent.
+[[Muscle spasms|Continuous muscle contractions]] can occur in the head, neck, and limbs and may cause a stiff tongue, arched back, or twisted neck. Dystonia also includes a lack of ability to move muscle and low muscle tone.
-'''Extrapyramidal symptoms''' (EPS), also known as '''extrapyramidal side effects''' (EPSE), are drug-induced movement disorders that include acute and tardive/chronic symptoms. They are mainly caused by the blockade of dopamine at dopaminergic receptors.
+Treatment of acute dystonia is often an anticholinergic agent and/or a benzodiazepine.{{citation needed}}
-==Symptoms==
+===Akathisia===
+Akathisia is characterized by restlessness, a need to move, constant sitting down and standing up, pacing, etc. Treatments for akathisia are anticholinergics, beta blockers, or [[benzodiazepines]]. Akathisia typically develops some time during a medication regimen{{citation needed}}
+===Psuedoparkinsonism===
+Psuedoparkinsonism occurs often further than akathisia.{{citation needed}} It is often noticed by seeing:
+*tremoring hands in a "pill-rolling" pose,
+*a stooped posture,
+*slowed movements,
+*shuffling, small steps,
+and others.  Others also include that when the person turns, they must do so very slowly and sometimes cannot change positions, such as standing to sitting, without a support.
+===Tardive dyskinesia===
+This disorder develops over long periods of time{{citation needed}} and is noticed by these signs: involuntary chewing, lip smacking or sucking, twitching, and/or involuntary movements of the limbs that are often jerky. It is treated by putting the patient on a dopaminergic medication regimen, such as using valbenzaine, tetrabenazine, ropinirole, or pramipexole.
-*'''Muscle contractions''' - Uncontrolled and severe contractions can occur in the head, neck, and limbs and may cause a stiff tongue, arched back, or twisted neck. Another sign is that the patient/victim finds it very difficult to talk, sometimes having the mouth "locked open."
-*Continuous '''[[muscle spasms]]'''
-*'''Restlessness''' - This can include nervous energy such as pacing or tapping one's foot.
-*'''Decreased bodily movement'''
-*'''[[Tremors]]'''
-*'''Stiff posture''' - This can include the lack of arm movement when walking.
-*Tardive or acute dyskinesia (irregular, jerky movements).<ref>Pierre, J. M. (2005). Extrapyramidal Symptoms with Atypical Antipsychotics. Drug Safety, 28(3), 191–208. https://doi.org/10.2165/00002018-200528030-00002</ref>
-**'''Uncontrolled movements''' - This may include uncontrolled movements of the tongue, jaw, lips, fingers, toes, or face, such as pursing one's lips, chewing, frequently blinking one's eyes, nodding one's head, or pelvic thrusting.
-*'''[[Irregular breathing]]''' or '''[[Respiratory depression|respiratory arrest]]''' - This may include grunts, gasping, sighing, or, in severe cases, the complete absence of breathing.
-*'''Weak voice''' or '''thick speech''' - The muscles in the mouth and throat as well as the face are likely too contracted and weakened to properly form sound.
-*'''[[Salivation]]'''
-*'''Lack of facial expression'''
 ==Causes==
 Extrapyramidal symptoms are most commonly caused by typical antipsychotic drugs that [[Antagonist|antagonize]] [[dopamine]] D2 [[receptors]].
-The most common typical [[antipsychotics]] associated with EPS are [[haloperidol]] and fluphenazine.<ref>Note, I. (2009). Extrapyramidal adverse effects Extrapyramidal adverse effects. Biomed Res Int., 2014, 30–32. https://doi.org/10.1155/2014/656370</ref>
+The most common typical [[antipsychotics]] associated with EPS are [[haloperidol]] and fluphenazine.<ref>Note, I. (2009). Extrapyramidal adverse effects. Biomed Res Int., 2014, 30–32. https://doi.org/10.1155/2014/656370</ref>
-Other anti-dopaminergic drugs, like the [[Nausea suppression|antiemetic]] metoclopramide, can also result in extrapyramidal side effects.<ref>Moos, D. D., & Hansen, D. J. (2008). Metoclopramide and Extrapyramidal Symptoms: A Case Report. Journal of Perianesthesia Nursing, 23(5), 292–299. https://doi.org/10.1016/j.jopan.2008.07.006</ref>
+Other antidopaminergic drugs, like the [[Nausea suppression|antiemetic]] metoclopramide, can also result in extrapyramidal side effects.<ref>Moos, D. D., & Hansen, D. J. (2008). Metoclopramide and Extrapyramidal Symptoms: A Case Report. Journal of Perianesthesia Nursing, 23(5), 292–299. https://doi.org/10.1016/j.jopan.2008.07.006</ref>
-Short and long-term use of antidepressants such as selective serotonin reuptake inhibitors ([[SSRI]]), serotonin-norepinephrine reuptake inhibitors (SNRI), and norepinephrine-dopamine reuptake inhibitors (NDRI) have also resulted in extrapyramidal symptoms. Specifically, duloxetine, sertraline, escitalopram, fluoxetine, and bupropion have been linked to the induction of extrapyramidal symptoms.<ref>Madhusoodanan, S., Alexeenko, L., Sanders, R., & Brenner, R. (2010). Extrapyramidal symptoms associated with antidepressants--a review of the literature and an analysis of spontaneous reports. Annals of Clinical Psychiatry : Official Journal of the American Academy of Clinical Psychiatrists, 22(3), 148–56. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20680187</ref>
+Short and long-term use of antidepressants, such as selective serotonin reuptake inhibitors ([[SSRI]]), serotonin-norepinephrine reuptake inhibitors (SNRI), and norepinephrine-dopamine reuptake inhibitors (NDRI) has also resulted in extrapyramidal symptoms. Specifically, duloxetine, sertraline, escitalopram, fluoxetine, and bupropion have been linked to the induction of extrapyramidal symptoms.<ref>Madhusoodanan, S., Alexeenko, L., Sanders, R., & Brenner, R. (2010). Extrapyramidal symptoms associated with antidepressants--a review of the literature and an analysis of spontaneous reports. Annals of Clinical Psychiatry : Official Journal of the American Academy of Clinical Psychiatrists, 22(3), 148–56. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20680187</ref>
 ==Treatment==
-[[File:Akineton Advertisement, 1966.jpg|400px|thumbnail|right|Advertisement for Akineton (biperiden).]]
+[[File:Akineton Advertisement, 1966.jpg|400px|thumbnail|right|Advertisement for Akineton (biperiden), used for pseudoparkinsonism.]]
 [[Acetylcholine|Anticholinergic]] drugs are used to control neuroleptic-induced EPS, although akathisia may require beta blockers or even [[benzodiazepines]]. If the EPS are induced by an [[antipsychotic]], EPS may be reduced by dose [[Tapering|titration]] or by switching to an atypical [[antipsychotic]], such as aripiprazole, ziprasidone, [[quetiapine]], olanzapine, [[risperidone]], or clozapine.
-Commonly used medications for EPS are [[acetylcholine|anticholinergic]] agents such as biperiden (Akineton), benztropine (Cogentin), [[diphenhydramine]] (Benadryl), and trihexyphenidyl (Artane). Another common course of treatment includes [[dopamine]] [[agonist]] agents such as pramipexole and ropinirole. These medications reverse the symptoms of extrapyramidal side effects caused by [[antipsychotics]] or other drugs that either directly or indirectly inhibit [[Dopamine|dopaminergic]] neurotransmission.
+Commonly used medications for EPS are [[acetylcholine|anticholinergic]] agents such as benztropine (Cogentin), biperiden (Akineton), [[diphenhydramine]] (Benadryl), and trihexyphenidyl (Artane). Another common course of treatment includes [[dopamine]] [[agonist]] agents, such as pramipexole and ropinirole. These medications reverse the symptoms of extrapyramidal side effects caused by [[antipsychotics]] or other drugs that either directly or indirectly inhibit [[Dopamine|dopaminergic]] neurotransmission.
+==Literature==
+==External links==
+[https://en.wikipedia.org/wiki/Extrapyramidal_symptoms Extrapyramidal symptoms (Wikipedia)]
 ==See also==
@@ Line 35: / Line 47: @@
 **[[Haloperidol]], one of the most common agents associated with EPS
 **[[Risperidone]], another agent known to induce EPS
+*[[Diphenhydramine]], an agent sometimes used to treat EPS
 *[[Responsible drug use]]
 *[[Dopamine]]
-==Citations==
+==References==
+[[Category:Approval]]