Master Antipsychotic Side Effects: Extrapyramidal Symptoms

Extrapyramidal side effects (EPS) represent one of the most tested topics on psychiatry board exams. These motor disturbances occur due to antipsychotic blockade of dopamine receptors in the nigrostriatal pathway.

Remember the "DAAPT" mnemonic to identify the five major EPS presentations:

Dystonia

Acute sustained muscle contractions causing abnormal postures; often affecting neck, jaw, and eyes. Typically occurs within days of starting treatment.

Akathisia

Subjective feeling of inner restlessness with objective motor restlessness. Patients often pace, shift weight, or fidget constantly.

Akinesia/Bradykinesia

Decreased spontaneous movement and slowed movement, respectively. Often misdiagnosed as depression or medication non-response.

Parkinsonism

Triad of rigidity, bradykinesia, and tremor. Classical pill-rolling tremor at rest. Usually develops within weeks to months.

Tardive Dyskinesia

Late-onset, potentially irreversible choreiform movements. Typically affects orofacial muscles with lip smacking and tongue protrusion.

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Extrapyramidal Side Effects of Antipsychotic Medications

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