What can we do about acute extrapyramidal symptoms?

Abstract

Antipsychotic drugs are the most effective treatment for psychotic disorders such as schizophrenia. However, they are known to cause a range of side-effects including acute extrapyramidal symptoms (EPS) that are both distressing and disabling. Mental health nurses play a critical role in both the detection and the management of these symptoms. A review of the literature was conducted to identify strategies for managing acute EPS. Despite a widely held belief that EPS are associated with noncompliance with medication, the data to support this hypothesis are weak. Although akathisia may negatively affect the treatment outcome, there was little evidence to suggest that parkinsonism or dystonia do. Whilst the use of anticholinergic medication may be helpful in treating acute parkinsonism and dystonia they were associated with their own side-effects and the benefit of long-term prophylactic treatment is doubtful. The literature suggests that logical prescribing and rapid detection and management of acute EPS will result in a substantial reduction in the incidence of these disabling side-effects.

Exploring the clinical and social determinants of prescribing anticholinergic medication for Chinese patients with schizophrenia

“…The rationale in most cases for such practice is the presumed prophylactic effect of ACM, although it is unnecessary in clinically stable patients who are free of EPS and receiving low doses of AP(s) (Ungvari et al, 2002). The higher EPS score in the ACM group may be due to the poor treatment response of EPS to trihexyphenidyl, the only oral ACM used in BJ and HK (Gray and Gournay, 2000).…”

“…These are mere assumptions and the reasons for this resistance needs to be further investigated. (3) Some clinicians are worried about the rebound phenomena including nausea, abdominal pain, restlessness, insomnia, akinetic depression, and even deterioration of the patients' mental state following the cessation of ACM (Gray and Gournay, 2000;Ungvari et al, 1997).…”

“…ACM itself is associated with a range of side effects (Gray and Gournay, 2000;Ungvari et al, 1999) which could inversely influence QOL (Kilian and Angermeyer, 2005). It was expected that patients on ACM would be more severely ill with poorer QOL.…”

Use of Anticholinergic Drugs in Patients with Schizophrenia in Asia from 2001 to 2009

“…Another factor could be the widely held belief in Asian societies that a combination of multiple drugs with different pharmacological features is more effective [26]. Some clinicians are also concerned about the rebound phenomena and the subsequent deterioration in patients' mental state following the cessation of ACM [27,28], Table 3 Factors associated with prescription of ACM in the whole sample by multiple logistic regression analysis with the non-ACM group as reference (n = 6441).…”

Cost-effectiveness analysis of antipsychotics in reducing schizophrenia relapses

“…The model assumes that four types of side effects could be experienced by patients: extra-pyramidal symptoms (EPS) [22], clinically significant weight gain (increase in weight of at least 7% from baseline) and glucose intolerance or diabetes as a representative feature of the metabolic syndrome. It must be noted that acute EPS did not include cases of tardive dyskinesia [9,23].…”