Extrapyramidal Symptoms: Types, Causes And Treatment
Since the synthesis of the first antipsychotics, patients with schizophrenia have seen their quality of life increase considerably. However, not everything is a bed of roses. Antipsychotics, like any psychotropic drug, have adverse effects that must be cured in health. A group of symptoms caused by the use of classic antipsychotics are the so-called extrapyramidal symptoms, which are characterized by affecting the patient’s movement.
To avoid complications, these symptoms must be detected quickly and treated as soon as possible. Let’s briefly review what extrapyramidal symptoms are and what are the causes that cause them.
They are a set of symptoms produced by the use of psychotropic drugs that manifest themselves by altering motor skills. Not all patients show all extrapyramidal symptoms; only a few are enough to be certain that what is being suffered is a condition caused by the adverse effects of the drugs.
Although used to be characteristic of psychotic patients taking antidepressants , the development of increasingly safe and selective drugs has allowed these conditions to not be so frequent. In those taking classic antipsychotics, the presence of extrapyramidal symptoms occurred in up to 75% of them, with the consequent decrease in quality of life and the obstacle to adherence to treatment. Older women appear to be the demographic most likely to experience extrapyramidal symptoms.
Its types
Typically We can divide extrapyramidal symptoms into four groups , all of them having in common that they affect the motor behavior of the individual. The most characteristic extrapyramidal symptoms are akathisia, dystonia, pseudoparkinsonism and dyskinesia.
Perhaps the most common extrapyramidal symptom is akathisia. It can be understood as a form of motor restlessness that is impossible to stop. Patients say they cannot sit still, so they cannot sleep well and their attention leaves much to be desired. They seem to be nervous all the time, they don’t stop swaying walking from one side to the other, moving the feet and hands, twisting of the neck, etc.
This is a very uncomfortable and exhausting symptom for those who suffer from it and it can be violent for those around the patient who do not know the reason for the concern, stigmatizing the patient and isolating them even more.
2. Dystonia
Extrapyramidal symptoms They also include involuntary muscle contractions of the neck, upper trunk and extremities. Almost as if they were the characteristic tics of Gilles de la Tourette Syndrome or its echopraxias. Most dystonias occur in the upper part of the body, especially the face.
Patients make extravagant faces that further accentuate the strange behavior caused by the rest of the extrapyramidal symptoms. Complications of this symptom can cause muscle problems such as torticollis or chronic muscle contractions.
3. Pseudoparkinsonism
This extrapyramidal symptom simulates the symptoms of Parkinson’s disease , but its sudden appearance makes it clear what its cause is. We are talking about tremors in the fingers, weakness of the voice, disappearance of the swing of the arms when walking due to great muscle rigidity, etc.
It can also be accompanied by bradypsychia, that is, slowed thinking when thinking about situations that should not involve great effort. With continued use of antipsychotics, pseudoparkinsomism also manifests itself through rabbit syndrome which are lip tremors and chewing movements.
These are involuntary movements of the muscles, almost always facial. Unlike dystonias, dyskinesias do not occur due to contractions. Are relatively complex and stereotyped movements, such as sticking out or curling the tongue , frowning, making sucking movements, etc. It is called late because it can take months or years to appear.
What is its cause?
Extrapyramidal symptoms occur when taking psychotropic drugs that block dopamine D2 receptors. Positive psychotic symptoms such as hallucinations or delusions occur due to the overactivation of dopaminergic pathways, so antipsychotics have the task of blocking the receptors in these pathways and calming the dopamine storms that are generated.
In the process, they also block the receptors in the basal ganglia, altering the person’s motor skills and giving rise to extrapyramidal symptoms. This is not the only mechanism involved, since it is known that both serotonin, norepinephrine and acetylcholine also participate in the appearance of these symptoms.
For this reason, typical antipsychotics, which mainly affect dopamine D2 receptors, are the main causes of extrapyramidal symptoms. This is one of the reasons why it was urgent to develop atypical or second-generation antipsychotics, which also include serotonergic action, causing this problem much less frequently.
Are extrapyramidal symptoms treated?
Rather than treating, what is done is a withdrawal of the drugs that cause it. When the reason is typical antipsychotics, currently out of use as a basic treatment, what is done is to replace them with something atypical. In some cases, reducing the dose is enough to quickly end the symptoms.
When you want to deal with very unpleasant acute reactions, it is possible to administer anticholinergics or antiparkinsonian drugs, which relieve suffering very quickly. However, it is necessary to be very careful with the dosage since these are drugs that can be lethal if one overdoses on them. Normally, to prevent extrapyramidal symptoms, it is enough to examine their presence or not through outpatient visits to the psychiatrist since it is easily solvable.
