Antipsychotic-related side effects
Parkinsonism Options Acute dystonia Options • Resting tremor (4–6Hz, slower than A. Reduce antipsychotic dose. • Involuntary upward gaze • Urgent medical treatment! physiologic or intention tremor) B. Switch to antipsychotic with less • Facial grimacing parkinsonism risk. • Intramuscular/ • Pill-rolling of hand • Laryngeal spasms C. Maintain antipsychotic; treat side effect with: intravenous (IM/IV) • Bradykinesia • Neck spasms benztropine 1–2mg • Benztropine 1–2mg twice a day (BID) • Rigidity • Abdominal wall spasms or or • Shuffling gait • Spine spasms • IM/IV diphenhydramine • Stooped posture • Diphenhydramine 25–50mg BID 25–50mg
Akathisia Barnes Akathisia Rating Scale is Tardive dyskinesia Abnormal Involuntary Movement Scale (AIMS) is expected: recommended. https://cpnp.org/ed/movement-disorders#scales. • Feels restless Repetitive, involuntary, Options: purposeless movement of: • Evaluate medications and medical conditions for other • Trouble causes of dyskinesia. standing still A. Reduce antipsychotic dose. • Face, mouth or tongue B. Switch to antipsychotic with less • Consider referral to neurology, ideally a movement • Paces • Upper or lower disorder specialist. akathisia risk. extremities • Feet Treatment constantly C. Maintain antipsychotic; treat side • Trunk moving or effect with: A. Trial reduction of antipsychotic dose rocking • Propranolol 10–30mg BID (titrate B. Quetiapine monotherapy switch in addition to response, BP, HR) or clozapine monotherapy • Clonazepam (0.5 to 1mg BID) or C. Trial of clonazepam augmentation • Lorazepam (1mg two to three times a D. Switch to clozapine day) or E. Use of other non-medication treatment modalities • Clonidine (0.1mg TID). such as electroconvulsive therapy
Abnormal Involuntary Movement Scale and Barnes Akathisia Rating Scale: https://cpnp.org/ed/movement-disorders#scales
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