Which of the following extrapyramidal effect is seen on chronic use of antipsychotic -
Dystonia
Akathisia
Tardive dyskinesia
Parkinsonism
Ans. is 'c' i.e., Tardive dyskinesia Neurological side effects of Neuroleptic DrugsReactionFeaturesTime of Maximal RiskProposed MechanismTreatmentAcute dystoniaSpasm of muscles of tongue, face, neck, back, may mimic sei- zures; not hysteria1 to 5 daysUnknownAntiparkinsonian ages are diagnostic and curativeAkathisiaMotor restlessness; not anxiety or "agitation"5 to 60 daysUnknownReduce dose or change drug; antiparkinsonian agents, benzodiazepines or propranolol may helpParkinsonismBradykinesia, rigidity, variable tremor, mask facies, shuffling gait5 to 30 days; can recur even after a single doseAntagonism of dopamineAntiparkinsonian agents helpfulNeuroleptic malignant syndromeCatatonia, stupor, fever unstable blood pressure myoglobinemia; can be fatalWeeks; can persist for days after stopping neuro- lepticAntagonism of dopamine may contri- buteStop neuroleptic immediately; dantrolene or bromocriptine may help; antiparkinsonism agents not effectivePerioral tremor "rabbit syndrome"Perioral tremor (may be a late variant of parkin- sonism)After months or years of treatmentUnknownAntiparkinsonian agents often helpTardive dyskinesiaOral-facial dyskinesia; widespread choreo- athetosis or dystoniaAfter months or years of treatment (worse on withdrawal)Excess function of dopamine hypothesizedPrevention crucial; treat- ment unsatisfactory
C.N.S