By Peter M. Haddad, Serdar Dursun, Bill Deakin
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Extra info for Adverse syndromes and psychiatric drugs: a clinical guide
Test for leadpipe or cogwheel rigidity & reduced glabellar tap. Management Reduce antipsychotic dose Switch antipsychotic Prescribe an anticholinergic Further reading Ayd FJ (1961). A survey of drug-induced extrapyramidal reactions. JAMA, 175, 1054–60. Barnes TRE and McPhillips MA (1995). How to distinguish between the neuroleptic-induced deficit syndrome, depression and disease-related negative symptoms in schizophrenia. International Clinical Psychopharmacology, 10, (Suppl. 3), 115–21. Osser DN (1999).
Irritability. Pharmacological mechanism Unclear. May reflect combination of a depressed dopaminergic system and an overactive noradrenergic system. Investigations to confirm diagnosis History and examination are key. Usually appears soon after starting/increasing dose of antipsychotic. Worsens with further dose increase, lessens with dose decrease. Reduce antipsychotic dose Management Switch antipsychotic Prescribe either an anticholinergic, benzodiazepine or propranolol. Try to prevent the condition by gradual titration of dosage when starting or increasing amount of antipsychotic medication.
Pp. 61–8. Blackwell Science: Malden, MA. Owens DGC (1990). Dystonia – a potential psychiatric pitfall. Br J Psychiatry, 156, 620–34. Pato CN, Wolkowitz OM, Rapaport M, et al. (1989). Benzodiazepine augmentation of neuroleptic treatment in patients with schizophrenia. Psychopharmacol Bull, 25, 263–6. Peuskens J (1995). Risperidone in the treatment of patients with chronic schizophrenia: a multinational, multicentre double-blind, parallel-group study versus haloperidol. Br J Psychiatry, 166, 712–26.