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Recognition and management of acute neuroleptic-induced
extrapyramidal motor and mental syndromes.
BKH Taufkirchen, Germany.
After nearly 50 years of
therapeutic application of neuroleptics, diagnosis and classification of
neuroleptic-induced extrapyramidal syndromes still concentrate on their
"neurological" (motor) aspects. Psychiatric (mental) aspects are in
general - if at all - regarded as "secondary" to motor symptoms.
Psychiatric side effects of neuroleptics (including psychotic
exacerbations during neuroleptic treatment) have, however, anecdotally
been reported since 1954 but never developed into a systematic
classification. Accordingly, psychiatric manifestations of
extrapyramidal side effects frequently are overlooked, misdiagnosed as
psychotic deteriorations and treated by increased dosing of neuroleptics
instead anticholinergics, which in addition are falsely suspected of
bearing a high addictive potential and the risk of development of
tardive dyskinesia. It is suggested that neuroleptic-induced basal
ganglia dysfunction results in motor as well as mental extrapyramidal
side effects, whose recognition and management is essential to achieve
better tolerability of and thereby compliance with neuroleptic
PMID: 11072761 [PubMed - indexed for