Info

Orthostatic hypotension, impotence

(^-Adrenoceptor block

Endocrine signs

Amenorrhea, galactorrhea, infertility, impotence

D2-receptor block resulting in hyperprolactinemia

Tardive dyskinesia is a late-occurring syndrome of abnormal movements of the face and tongue with widespread choreoathetosis. It is the most serious adverse effect of the antipsychotic drugs. It can be expected to occur in 20 to 40% of chronically treated patients; there is no established treatment, and reversibility may be limited. These reactions are more frequent and severe in the elderly.

Tardive dyskinesia is generally accepted to be a D2 supersensitivity phenomenon, though research has not unequivocally established this postulate. An appropriate clinical response to these symptoms would be to reduce the dose or discontinue the antipsychotic agent and then eliminate all drugs with central anticholinergic action, such as antidepressants. The rationale is to balance the risks of continuing treatment in a patient with tardive dyskinesia with the benefits of antipsychotic administration. If these steps are not helpful, clozapine therapy can be considered, or diazepam can be employed to enhance GABAergic activity. Prevention of this reaction is important. Generally, antipsychotics should be prescribed in minimally effective doses and their use reserved for time-limited treatment except in the treatment of chronic schizophrenic disorders.

The neuroleptic malignant syndrome is a rare medical emergency involving extrapyramidal symptoms that occurs in about 1% of patients receiving antipsychotics. The concern is not the incidence but that about 10% of these cases are fatal. The condition is marked by hyper-thermia or fever, diffuse muscular rigidity with severe extrapyramidal effects, autonomic dysfunction such as increased blood pressure and heart rate, and fluctuating levels of consciousness. Neuroleptic malignant syndrome is most common in males, with about 80% of cases occurring in patients under 40 years of age. Treatment should include general supportive measures, such as rehydration and body cooling; antipsychotic therapy should be discontinued. Short-term therapy with dantrolene in combination with antiparkinson agents such as bromocriptine has been employed to control the muscular rigidity and hyperthermia.

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