Table of ContentsView AllTable of ContentsSymptomsCausesPatient RightsDiagnosisTreatmentPreventionSummaryFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Patient Rights
Diagnosis
Treatment
Prevention
Summary
Frequently Asked Questions
Extrapyramidal symptoms (EPS) are serious side effects that can develop after taking certain antipsychotic medications. They can affect your motor control and coordination. EPS can take several forms, including tardive dyskinesia.
Tardive dyskinesiacauses uncontrollable facial movements. It develops after long-term use of certain psychiatric medications that block the neurotransmitter (chemical messenger)dopamine, which plays a role in pleasure and movement.Typical onset of symptoms is about three months after starting the medication. Tic-like movements and involuntary eye blinking are common early signs.
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The extrapyramidal system controls voluntary movements. Damage to this system—mostly in a part of the brain called thebasal ganglia, a set of structures involved in the integration of multiple sources of information—can result in serious problems with your motor function.
Extrapyramidal symptoms can include:
While tardive dyskinesia falls under the general umbrella of extrapyramidal symptoms, it has very specific characteristics. EPS describes a broad range of symptoms that come on soon after starting certain medications but are not usually permanent. Tardive dyskinesia, on the other hand, involves very specific nonrhythmic involuntary movements that develop later on after long-term medication use. Symptoms of tardive dyskinesia are usually milder and may not be reversible.
The main features of tardive dyskinesia include:
RecapThere are many kinds of extrapyramidal symptoms, and tardive dyskinesia (TD) is one of them. Chewing, lip smacking, and curling the tongue are common TD symptoms.
Recap
There are many kinds of extrapyramidal symptoms, and tardive dyskinesia (TD) is one of them. Chewing, lip smacking, and curling the tongue are common TD symptoms.
The goal of antipsychotic medications is to help control mental disorders likeschizophrenia.While these medications work well in treating mental disorders, many are avoided because they can cause severe side effects. Extrapyramidal symptoms develop when dopamine is suppressed, which is what antipsychotic medications do.
There are three classes of antipsychotic medications:
Extrapyramidal symptoms can appear with other conditions, like Parkinson’s disease, but tardive dyskinesia is specific to the use of antipsychotics.
How Common Is Tardive Dyskinesia With Antipsychotic Use?Tardive dyskinesia develops within the first year in 6% to 12% of people who take even low-dose antipsychotics.Age can impact the likelihood of developing TD, with 25% to 45% of people over age 45 developing TD after a year of treatment.
How Common Is Tardive Dyskinesia With Antipsychotic Use?
Tardive dyskinesia develops within the first year in 6% to 12% of people who take even low-dose antipsychotics.Age can impact the likelihood of developing TD, with 25% to 45% of people over age 45 developing TD after a year of treatment.
Beyond antipsychotics, several other medications have also been linked to tardive dyskinesia. These include:
Many people who are prescribed antipsychotics have conditions like schizophrenia or dementia. Since these conditions can impair your ability to make decisions, concerns have been raised about the forceful administration of these medications.
RecapRemember, you have the right to refuse medications, especially ones that are sedating.
Remember, you have the right to refuse medications, especially ones that are sedating.
Diagnosing extrapyramidal symptoms and tardive dyskinesia is typically direct. Your doctor will learn whatmedicationsyou are taking and may quickly make the connection between your symptoms and the use of antipsychotic medications.
With some extrapyramidal symptoms, other conditions like Parkinson’s disease will need to be ruled out. There are a number of assessments your doctor may use to diagnose you with these conditions, but most of them rely on observation, questioning, and an assessment of your health and medication history.
The primary way to treat extrapyramidal symptoms and tardive dyskinesia is to change medications or dosing or stop antipsychotics altogether. Stopping antipsychotic use or changing dosing may help relieve extrapyramidal symptoms, while the impact on tardive dyskinesia is less clear.
Schizophrenia and other conditions that present with psychotic episodes can be difficult to manage, but for many people with these conditions, the medications used to treat them are even harder to bear. More than 20 years of studies revealed that up to 50% of people who take antipsychotic medications don’t take them as they should, largely because of the negative side effects they produce.
Up to half of people with tardive dyskinesia may experience worsening symptoms when stopping medications, although many see improvement over time. In some cases, symptoms are permanent. Arguments can be made both for maintaining and stopping antipsychotic use for tardive dyskinesia because stopping may or may not result in improvement. Stopping antipsychotics, on the other hand, can lead to increases in thepsychoticsymptoms the medications are prescribed to treat in the first place.
RecapYou may need to change your medication or dosing to help your symptoms, but don’t ever make medication changes without talking to your doctor first.
You may need to change your medication or dosing to help your symptoms, but don’t ever make medication changes without talking to your doctor first.
If you have a condition that needs to be treated with antipsychotic medications, it can be difficult to completely prevent extrapyramidal symptoms and tardive dyskinesia. If you have been prescribed an antipsychotic medication, you may want to talk to your doctor about the benefits and risks of using first-, second-, or third-generation antipsychotics, as well asnon-pharmacological optionsfor treating your condition.
A Word From Verywell
Talk to your doctor if you are experiencing negative side effects while taking antipsychotic medications. Be aware that stopping these medications may or may not improve your symptoms, but can lead to a relapse in psychotic episodes. Consult your doctor before stopping or changing medication dosages on your own.
Frequently Asked QuestionsBoth of these conditions affect your motor function, but tardive dyskinesia symptoms mostly affect the face and mouth.All antipsychotics can cause EPS, but typical or first-generation antipsychotics like chlorpromazine and Haldol (haloperidol) carry the greatest risk.Tardive dyskinesia is a form of EPS that features a later onset. You may experience early EPS symptoms and develop tardive dyskinesia after long-term use of antipsychotic medications.Second-generation antipsychotics are associated with lower rates of EPS and tardive dyskinesia, but it is still possible to experience these side effects with second-generation medications.These are small-movement tremors in your fingers that can make it look like you are moving a small pill between your fingers. This is an early symptom of Parkinson’s disease and is a form of EPS.
Both of these conditions affect your motor function, but tardive dyskinesia symptoms mostly affect the face and mouth.
All antipsychotics can cause EPS, but typical or first-generation antipsychotics like chlorpromazine and Haldol (haloperidol) carry the greatest risk.
Tardive dyskinesia is a form of EPS that features a later onset. You may experience early EPS symptoms and develop tardive dyskinesia after long-term use of antipsychotic medications.
Second-generation antipsychotics are associated with lower rates of EPS and tardive dyskinesia, but it is still possible to experience these side effects with second-generation medications.
These are small-movement tremors in your fingers that can make it look like you are moving a small pill between your fingers. This is an early symptom of Parkinson’s disease and is a form of EPS.
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Cornett EM, Novitch M, Kaye AD, Kata V, Kaye AM.Medication-induced tardive dyskinesia: a review and update.Ochsner J. 2017;17(2):162-174.
Sanders RD, Gillig PM.Extrapyramidal examinations in psychiatry.Innov Clin Neurosci.July 2012;9(7-8):10-16.
Sanders RD, Gillig PM.Extrapyramidal examinations in psychiatry.Innov Clin Neurosci. 2012;9(7-8):10-16.
Haddad PM, Brain C, Scott J.Nonadherence with antipsychotic medication in schizophrenia: challenges and management strategies.Patient Relat Outcome Meas. June 23, 2014;5:43-62. doi:10.2147/PROM.S42735
Guzman F.First vs second- generation antipsychotics.Psychopharmacology Institute.
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