Sunday, February 1, 2015

Study group discussion: Extrapyramidal effects of antipsychotics and treatment

Guys do you know the side effect/time line of antipsychotics?

I mix up akathisa  akinesia etc. Then there's tardive dyskinesia and dystonia!
So confusing.

4 hours dystonia
4 days akinesia
4 weeks akathesia
4 months tardive dyskinesia

Thank you!

I was discussing timeline of extra pyramidal side effects of antipsychotics earlier and got a doubt - Some books say akinesia comes before akathesia while others say akathesia comes before akinesia.
Like my book says opposite of the image of a book posted by someone on the group and I couldn't find a good resource online.
Anyone has an insight on what we actually see clinically?

Well after asking around it seems the general consensus is that akathisia precedes akinesia. At since it has logic to it that's what I'm sticking with.

Thanks! Why is it logical though? Because Parkinsonian symptoms take longer to appear?

Well akathisia is restlessness and agitation, and akinesia is when you start losing voluntary movements, and it seems logical that it would precede dyskinesia.

Makes sense to me now, thanks!

Hey concerning the extrapiramidal effects of antipsychotics, I consulted my Goodman and Gilman and found this:
Akathesia: 5-60 days.
Parkinsonian symptoms: 5-30 days.
There we go. Basically the argument could be made for either order since their appearance overlaps.

Oh. So you can't have a clear cut line. Thanks for this!

You use anticholinergics for akinesia, right?

Yes, right. And for akathisia beta blockers like propanolol is drug of choice.

Ohh and what's the treatment for dystonia?

Probably Anticholinergics or muscle relaxant like baclofen. Not confirmed.

Dopaminergic drugs
Anticholinergic drugs
GABA Agonists
Carbamazepine
They all can be used in dystonia!

Woah. I didn't know this.

Dopaminergic drugs like?

Levodopa

Here's a post I wrote after this discussion - Antipsychotics: Timing of evolution of extra pyramidal symptoms mnemonic  http://medicowesome.blogspot.com/2015/01/antipsychotics-timing-of-evolution-of.html

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