TABLE 16-1 - Neuroleptic lnduced Movement Disorders

Disorder	Risk Factors	Onset	Treatment
Dystonia	High-potency antipsychotics Young men	First few days of therapy	IM/IV benztropine or diphenhydramine Severe laryngospasm may require intubation
Akathisia	Recent increase/onset of medication dosing	First month of therapy	Propanolol, lorazepam (maybe anticholinergics)
EPS	High-potency antipsychotics Elderly Prior episode of EPS	First few weeks of therapy	Anticholinergic Lower antipsychotic dosage or change to lower-potency antipsychotic
NMS	High-dose anti psychotics, rapid dose escalation, or IM injection of anti psychotics Agitation, dehydration Prior episode of NMS	Usually within first few weeks; can occur at any point in antipsychotic therapy	Discontinue antipsychotic medication Supportive symptom management Dantrolene, bromocriptine May require intensive care
Tardive dyskinesia	Elderly Long-term antipsychotic treatment Female African American Mood disorders	Usually after years of treatment	Lower dosage of antipsychotic Change antipsychotics Change to clozaril

The DSM-IV classification for these disorders defines them as neuroleptic-induced movement disorders. The term neuroleptic generally refers to typical antipsychotics (see Chapter 11). Exceptions include risperidone, which is classified as an atypical antipsychotic but can cause all the above disorders; SSRls, which are not neuroleptic drugs but can clearly produce akathisia; and clozaril, which does not appear to produce dystonia, akathisia, EPS, or tardive dyskinesia but may cause NMS.