Extrapyramidal symptoms: types, causes and treatment

These symptoms are associated with the effect of certain psychotropic drugs, and generate motor problems.

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 guarded against. One group of symptoms caused by the use of classical antipsychotics are the so-called extrapyramidal symptoms, which are characterized by affecting the patient's movement..

To avoid complications, these symptoms should be detected promptly and treated as soon as possible. Let us briefly review what extrapyramidal symptoms are and what causes them.

What are extrapyramidal symptoms?

They are a group of symptoms produced by the use of psychotropic drugs that manifest themselves by altering the motor function.. Not all patients show all the extrapyramidal symptoms; only some of them are sufficient 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 increasinglyThe development of increasingly safer and more selective drugs has allowed these symptoms to become less frequent. In those taking classical antipsychotics, the presence of extrapyramidal symptoms occurred in up to 75% of them, with the consequent decrease in quality of life and the resulting obstacle to treatment adherence. Older women seem to be the demographic most prone to extrapyramidal symptoms.

Their types

Typically extrapyramidal symptoms can be divided into four groupsall of them having in common that they affect the individual's motor behavior. The most characteristic extrapyramidal symptoms are akathisia, dystonia, pseudoparkinsonism and dyskinesia.

Akathisia

Perhaps the most frequent extrapyramidal symptom is akathisia. It can be understood as a form of motor restlessness that is impossible to stop. Patients report not being able to sit still at all, so that they cannot sleep well either and their attention leaves much to be desired. They seem to be nervous all the time, they can't stop swaying, pacing back and forth, and they can't stop walking.They seem to be nervous all the time, they keep swaying, walking to and fro, moving their feet and hands, twisting their neck, and so on.

It is a very uncomfortable and exhausting symptom for the sufferer and can be very for who suffers it and can be violent for those who surround the patient and do not know the reason for the restlessness, stigmatizing the patient and isolating him even more.

2. Dystonia

Extrapyramidal symptoms involuntary contractions of the muscles of the neck, upper trunk and of the neck, upper trunk and extremities. Almost like the characteristic tics of Gilles de la Tourette syndrome or its ecopraxias. Most dystonia occurs in the upper body, especially in the face.

Patients make extravagant grimaces that further accentuate the bizarre behavior caused by the rest of the extrapyramidal symptoms. Complications of this symptom even cause muscular problems such as torticollis or chronic Muscle contractions.

3. Pseudoparkinsonism

This extrapyramidal symptom simulates the symptoms of Parkinson's disease.but its sudden onset makes its cause clear. We speak of tremors in the fingers, weakness of the voice, disappearance of the swinging of the arms when walking due to a great muscular rigidity, etcetera.

It can also be accompanied by bradypsychia, that is, slowed thinking when thinking about situations that should not involve a great effort. With continued use of antipsychotics, pseudoparkinsomism also manifests itself through the rabbit syndromewhich are tremors of the lips and chewing movements.

4. Tardive dyskinesia

These are involuntary movements of the musculature, almost always facial. Unlike dystonia, dyskinesias do not occur due to contractions. They are relatively complex and stereotyped movements, such as sticking out or folding the tongue, frowningfrowning, frowning, sucking movements, and so on. It is called tardive because it may take months or years to appear.

What causes it?

Extrapyramidal symptoms occur when taking psychotropic drugs that block dopamine D2 receptors. Positive psychotic symptoms such as hallucinations or delusions occur due to overactivation of dopaminergic pathways, so antipsychotics have the task of blocking receptors in these pathways and calming the dopamine storms that are generated.

Incidentally, they also block 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 serotonin, noradrenaline and acetylcholine are also known to participate in the onset of these symptoms. in the appearance of these symptoms.

This is why typical antipsychotics, which mainly affect dopamine D2 receptors, are the main causes of extrapyramidal symptoms. This is one of the reasons why atypical or second-generation antipsychotics, which also include serotonergic action, were developed as a matter of urgency, causing this problem much less frequently.

Are extrapyramidal symptoms treated?

More than treating, what is done is a withdrawal of the drugs that cause them. When the reason is typical antipsychotics, nowadays in disuse as a basic treatment, what is done is to substitute them with atypical ones. In some cases the reduction of the dose is already enough to quickly end the symptoms.

When very unpleasant acute reactions are to be dealt with, it is possible to administer anticholinergics or antiparkinsonians, which alleviate the suffering very quickly. However, it is necessary to be very careful with the dosage as these drugs can be lethal if one overdoses with them. Normally, for the prevention of extrapyramidal symptoms, it is sufficient to examine their presence or absence through outpatient visits to the psychiatrist, since they are easily solvable.