Extrapyramidal Symptoms with Atypical Antipsychotics

  title={Extrapyramidal Symptoms with Atypical Antipsychotics},
  author={Joseph M. Pierre},
  journal={Drug Safety},
The treatment of schizophrenia changed drastically with the discovery of antipsychotic medications in the 1950s, the release of clozapine in the US in 1989 and the subsequent development of the atypical or novel antipsychotics. These newer medications differ from their conventional counterparts, primarily based on their reduced risk of extrapyramidal symptoms (EPS). EPS can be categorised as acute (dystonia, akathisia and parkinsonism) and tardive (tardive dyskinesia and tardive dystonia… 

Implications of the CATIE Trial on Treatment: Extrapyramidal Symptoms

  • D. Casey
  • Psychology, Medicine
    CNS Spectrums
  • 2006
The reported results of the CATIE trial regarding EPS are explored and the differentiation of the atypicals from perphenazine on EPS is emphasized and how these results should be incorporated into daily practice for the clinician is emphasized.

Aripiprazole in the Treatment of Schizophrenia

Overall, in the experience, aripiprazole is generally a well accepted, well tolerated, safe and broadly effective first-line antipsychotic agent.

Incidence of Extrapyramidal Symptoms and Tardive Dyskinesia in Schizophrenia: Thirty-Six-Month Results From the European Schizophrenia Outpatient Health Outcomes Study

Patients treated with typical antipsychotic agents (oral and depot) and risperidone had a higher risk of developing EPS and TD than patients treated with olanzapine, and baseline factors associated with a significantly higher risk were age, EPS, a higher negative Clinical Global Impression score, and presence of gynecomastia.

Tardive dyskinesia: eliminated, forgotten, or overshadowed?

  • G. Remington
  • Psychology, Medicine
    Current opinion in psychiatry
  • 2007
The limited evidence available clearly indicates that the atypical antipsychotics have a decreased liability of tardive dyskinesia, approximately 1% compared with 5% for typical agents annually.

Are Atypical Antipsychotics the Least Detrimental Alternative?

  • Holly Breton
  • Psychology, Medicine
    McMaster University Medical Journal
  • 2019
The benefits of the atypical antipsychotics (reduced extrapyramidal symptoms) outweigh the potential risks for the majority of patients, and metabolic syndrome may be preventable in highly motivated and well-supported patients.

Benzodiazepines for antipsychotic-induced tardive dyskinesia.

There is only evidence of very low quality from a few small and poorly reported trials on the effect of benzodiazepines as an adjunctive treatment for antipsychotic-induced tardive dyskinesia.

A genetic dissection of antipsychotic induced movement disorders.

A review of the literature about the APM induced EPM to provide some rational genetic candidates to be tested in further genetic investigations and a reasoned list of candidate genes and their genetic variations that balances the limitations of multitesting with the advantages of the tagging approach.


This paper gives a brief sum- mary of the literature with the emphasis on epidemiology, eti- ology, diagnosis and differential diagnosis, as well as the treatment of extrapyramidal disorders induced by antipsy- chotics, including dystonia and akathisia.

Atypical Antipsychotic Adjustments and Side-Effects over Time in Adults with Intellectual Disability, Tardive Dyskinesia, and Akathisia

People with TD or akathisia who experienced changes in atypicals were more likely to evince side effects, and trends were evident across total MEDS scores and subscales for cardiovascular and hematology, CNS for parkinsonism/dyskinesia and behavioral/akath isia.



Extrapyramidal symptoms and tolerability of olanzapine versus haloperidol in the acute treatment of schizophrenia.

The lower extrapyramidal symptom profile with olanzapine was evident despite statistically significantly more frequent use of anticholinergic drugs among haloperidol-treated patients, suggesting that olanZapine should contribute to better compliance with longer term maintenance treatment, with minimal anticholergic-associated events.

The treatment of tardive dyskinesia and tardive dystonia.

  • G. Simpson
  • Psychology, Medicine
    The Journal of clinical psychiatry
  • 2000
The enthusiasm produced by the introduction of antipsychotic medication in the 1950s gave way to a certain frustration in the 1970s and 1980s, and it is possible that schizophrenic patients taking atypical antipsychotics may experience fewer spontaneous dyskinesias, although further study is warranted.

Extrapyramidal signs and clinical symptoms in first-episode schizophrenia: response to low-dose risperidone.

Analysis of symptom response of the lower versus the higher doses of risperidone resulted in superior outcome in the 2- to 4-mg group for all three symptom clusters of the PANSS, which has clinical relevance directed at the early and longer-term treatment of schizophrenia.

Treatment of tardive dyskinesia.

Although the new generation of atypical antipsychotic agents could some day eliminate concerns about tardive dyskinesia, this disorder remains a significant clinical problem for patients and physicians and efforts to understand the neurobiology of TD may shed light on this persistent clinical conundrum.

The Risks and Benefits of Clozapine versus Chlorpromazine

It is suggested that clozapine is well tolerated and may be therapeutically superior to chlorpromazine in treating psychotic behavior and agranulocytosis potential can be minimized by frequent white blood cell counts and removing nonresponding patients from treatment prior to the peak risk period.

Frequency of Extrapyramidal Adverse Reactions in Schizophrenic Outpatients Treated with Risperidone, Olanzapine, Quetiapine or Haloperidol

The results suggest that the atypical antipsychotics studied are less likely to induce extrapyramidal adverse reactions compared with haloperidol in stabilised patients, although these reactions are still common.

Three cases of improvement of tardive dyskinesia following olanzapine treatment.

Olanzapine is a serotonin-dopamine-receptor antagonist, which has an affinity for neuroreceptors similar to that of clozapine, and Pooled tolerability data from controlled trials show that the overall incidence of TDk in patients treated with olanzAPine is significantly lower than in patients treating with haloperidol.

Atypical antipsychotics: are some more atypical than others?

Current clinical evidence is reviewed to compare current clinical evidence on four measures of atypicality: EPS, prolactin elevation, superior efficacy in refractory/positive symptoms and efficacy against negative symptoms.

Therapeutic strategies against tardive dyskinesia. Two decades of experience.

Although neuroleptics are significantly superior to most other methods of treatment in suppressing signs of dyskinesia, the safety of their long-term use in dyskinetic patients remains to be demonstrated.

Clozapine in tardive dyskinesia: observations from human and animal model studies.

The data suggest that dyskinetic patients lose their symptoms of tardive dyskinesia, along with dopaminergic hypersensitivity, with long-term clozapine treatment.