Neurological complications
Extrapyramidal system disorders are a frequent companion of therapy with typical antipsychotics (e.g., haloperidol):
- Acute spasms (dystonia): occur suddenly, most commonly at the start of treatment. They require slow dose titration and, in emergency cases, the administration of biperiden or tranquilizers.
- Drug-induced parkinsonism: provoked by the blockade of dopamine receptors in the neostriatum. Managed by dose reduction or the administration of anticholinergics and amantadine. Important: Levodopa is contraindicated due to the risk of psychosis.
- Akathisia: persistent motor restlessness, a constant urge to change posture, and insomnia.
- Tardive dyskinesia: persistent hyperkinesia of the face and head, which does not disappear upon drug withdrawal, but rather intensifies.
Somatic and autonomic effects
In addition to the nervous system, therapy affects the somatic sphere:
- Blood pressure reduction: drugs with a pronounced sedative effect can cause orthostatic collapse. Patients are advised to avoid sudden standing up.
- Anticholinergic manifestations: dry mouth, constipation, impaired accommodation, and occasional urinary retention.
- Metabolic disorders: increased appetite due to antihistamine action and hyperprolactinemia lead to noticeable weight gain.
- Sexual dysfunctions: develop due to sedation and hormonal shifts, and are frequently concealed by patients.
Neuroleptic malignant syndrome
NMS is a rare but life-threatening condition. Its clinical presentation includes:
- Pronounced hyperthermia;
- Arterial hypertension;
- Impaired consciousness;
- Psychomotor agitation.
Management in the event of NMS requires immediate withdrawal of the antipsychotic and emergency intensive care under strict monitoring of vital functions.
Atypical agents and safety profile features
Atypical antipsychotics significantly reduce the risk of classical extrapyramidal disorders. Nevertheless, they have their own drawbacks:
- Pronounced metabolic impact (risk of metabolic syndrome and obesity);
- Alteration of cardiac conduction with Q-T interval prolongation (especially with ziprasidone, sertindole, and thioridazine);
- Piperidine derivatives (e.g., thioridazine) have a milder profile and less frequently cause movement disorders, but at high doses can cause retinopathy (retinal degeneration).
Class and exam questions
Why is Levodopa contraindicated in drug-induced parkinsonism?
The administration of Levodopa can provoke a sharp exacerbation of psychosis in the patient.
What happens to tardive dyskinesia upon antipsychotic withdrawal?
Persistent hyperkinesia does not disappear upon drug withdrawal, but conversely intensifies due to compensatory upregulation of dopamine sensitivity.
Which drugs reduce the risk of extrapyramidal disorders?
The probability is significantly lower when using atypical antipsychotics, and among typical ones, in drugs with strong anticholinergic activity, such as chlorpromazine or chlorprothixene.
What else to study on this topic
- The role of histamine and alpha-adrenergic receptors in the development of adverse effects
- Comparison of typical and atypical antipsychotics regarding their metabolic profile
- Risk factors and patient groups for tardive dyskinesia
- Differential diagnosis of anticholinergic delirium and psychosis
- Monitoring of blood counts during clozapine therapy
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Other topics in "Chapter 17. Therapy of Mental Disorders. Basic Principles of Prevention and Rehabilitation"
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