INTOLERANCE TO NEUROLEPTIC DRUGS - THE ART OF AVOIDING EXTRAPYRAMIDALSYNDROMES

Akathisia, dystonia, dyskinesia and parkinsonism, the four main catego ries of neuroleptic-induced extrapyramidal syndromes (EPS), represent major disadvantages in antipsychotic therapy. In vulnerable patients, acute EPS may progress into potentially irreversible forms such as tar dive dystonia and tardive dyskinesia. In the psychiatric clinic, these EPS are often insufficiently recognised or permitted to exist without treatment. In order to ensure a better EPS diagnosis, a simple examin ation procedure is described. EPS rating scales may serve as an aid in this process. Guidelines are given to prevent and treat EPS. Thus, EP S are best prevented by a course of neuroleptic medication involving a s little antidopaminergic D-2 effect as possible, including the use of the lowest effective dose (sometimes obtained by addition of a benzod iazepine or carbamazepine) and with antipsychotic drugs which produce low D? receptor blockade. Treating EPS also consists of using the lowe st effective dose and antipsychotics with a low D-2 dopamine receptor occupancy. At present, clozapine is the only drug that produces antips ychotic benefits at doses that cause far less D-2 receptor antagonism in the basal ganglia of the brain than that seen with standard neurole ptics; however, newer drugs, such as olanzepine, seroquel and sertindo le, are on the way.