Extrapyramidal Symptoms (EPS)
Extrapyramidal symptoms is the topic and abbreviated eps and extrapyramidal symptoms are essentially side effects of antipsychotic medications that can occur and these are commonly tested on the licensing exams there’s four types and i’ll try to go through all four and describe each of the four types and then i’ll tell you how each of the four types is dealt with
In terms of treatment or management so the first of the four types of extrapyramidal symptoms is something called dystonia and a typical scenario is that some patient that is being treated for let’s say some psychiatric disorder perhaps schizophrenia is placed on an antipsychotic medication and then shortly afterwards develops dystonia so what happens what is
Dystonia well dystonia is described as sort of an acute muscle stiffness or muscle rigidity that can occur and also there’s spasms of the body and the patient can also demonstrate some weird eye eye movements known as eye deviations and that’s basically dystonia so think of like a muscle spasm or muscle stiffness or some sort of a forced deviation of the
Eyes now this is treated with an anticholinergic medication anticholinergic and that medication is benztropine and benztropine will help with these symptoms and it’s most commonly given as an im shot so remember that and that’s actually important the next type of extrapyramidal symptom that can happen with the treatment of some sort of antipsychotic medication
Is something known as akathesia now what’s akathesia is uh the best way to think about it is a person who just can’t sit still restlessness very restless unable to sit still also this patient will probably stand up and sit down stand up and sit down many times pace around constantly and this is a rather worrisome troublesome side effect of being treated with
An antipsychotic medication but this can be treated fortunately by calming the patient down with a benzodiazepine lorazepam the third type of eps extra pyramidal symptom is something known as parkinsonism parkinsonism and the the reason this happens is antipsychotic medications basically work by lowering dopamine levels so they lower the dopamine level in
The brain now when you have this iatrogenic lowering of the dopamine in the brain you can develop actually parkinsonism which is essentially a condition that occurs with low dopamine levels so you’ve actually caused parkinsonism with this antipsychotic medication a terrible side effect now the symptoms of parkinsonism without going into too much detail a lot
Of this is a very characteristic you’ll see something called a shuffling gate uh something called mask faces and what’s mask faces mass faces is basically an expressionless expressionless uh face that’s what mask faces means um the the person may also exhibit some drooling and the patient will also experience some sort of rigidity or tremor rigidity or
Tremor so these are some of the characteristic findings of parkinsonism how do you treat this well uh you can symptom symptomatology or the symptomatic treatment of this involves either an antihistamine such as a diphenhydramine or or an anticholinergic such as benztropine so that’s how this is treated and then the final eps the fourth and final one is known
As tardive dyskinesia and what start of dyskinesia the best way to describe this is basically involuntary movements of the oral facial muscles and i’ll give you some examples the first one for example is a tongue the tongue will protrude involuntarily so it’s rather embarrassing problem another one is uh involuntary puckering puckering is like for example you
Know when people pucker their lips before they’re about to kiss somebody that’s what puckering means another thing that can happen is uh chewing involuntarily of course and then grimacing so these are some unfortunate kind of bothersome side effects that are all characterized as tardive dyskinesia treatment of this what is it unfortunately there’s no medication
That treats tardive dyskinesia if a patient develops targeted dyskinesia while on antipsychotic medications the only option you really have is to take them off the current antipsychotic and switch to another antipsychotic such as clozapine switch to a basically an atypical an atypical antipsychotic medicine such as clozapine there’s another one called risperidone
And that’s really the only way you can treat or manage this so let’s uh take a look at some vignettes a 35 year old man is brought to the emergency clinic by his mother because of an episode of slurred speech associated with the uncomfortable sensation that his tongue is thick and curling up the episode started 30 minutes ago the patient is noted to be holding
On to his tongue and thumb with his forefinger when asked about this the patient responds with dysarthria saying that his medication has caused this once before and that he needs a shot to make it go away the mother reports that the patient had schizophrenia for 10 years and constantly consistently takes two medications prescribed by the psychiatrist several
Days ago he ran out of one of the medications but has continued to take the other one what is the most appropriate initial step in the management of this patient well it’s clear that this patient is experiencing some sort of eps and the aps the extrapyramidal symptom that he’s associated that he’s experiencing actually is a dystonia type reaction and this
Question actually is interesting that he’s already told you that he needs a shot to make it go away and the shot that he needs is a medication that is an anticholinergic and it’s ben’s tropine and that i am shot of ben’s troping will be the solution to this and that would be b the next question a 64 year old man is undergoing inpatient psychiatric treatment
With haloperidol after several days of therapy the patient complains that he feels very restless and agitated and he cannot stop moving his legs he paces constantly sits and then stands and is unable to sit still which of the following medication if given during his initial regimen might have best prevented this reaction this is a perfect example of someone
Experiencing akathesia and akathesia is treated with the benzodiazepine such as laura zapim so that would be the answer there and the last one a 54 year old man a woman sorry presents to her primary care physician for routine yearly health maintenance exam she denies any medical problems only significant medical history includes a 25-year his only significant medical
Which has been well controlled with anti-psychotic agents five year history of hypertension for which she takes a diuretic vital signs and physical exam with the normal limits however patient has noted an occasional irregular puckering and lip smacking movements she denies having noticed the abnormal movements and her speech is normal which of the following is most
Like a diagnosis well now this is a good question where she has these involuntary movements of the oral uh facial muscles and the puckering and the lip smacking movements are really the the ones described in this clinical vignette and this is basically part of dyskinesia and tardive dyskinesia is managed by discontinuing the current medication and switching
To another one such as clozapine or respirodone
Transcribed from video
Extrapyramidal Symptoms By CanadaQBank