EPS. .pptx

Mental

1. PSYCHIATRIC MENTAL HEALTH NURSING GROUP 5b QN:EXTRAPYRAMIDAL SIDE EFFECT (EPS)

2. Learning objective By the end of this topic every one will be able to Define extrapyramidal side effect Describe common major extrapyramidal side effect Management of each major EPS Assessment scale of AIMS

3. introduction When the substantial number of D2 receptor are blocked in the nigrostriatal DA pathway, this will produce various disorder of the movement that can appear very much like those in the Parkinson's disease Sometime this movement are called drug induced parkinsonism The major function of dopamine is to control voluntary movement Since the nigrostriatal pathway is part of the extrapyramidal nervous system .when the D2 is blocked will show sign of EPS

4. Definition Extrapyramidal side effect refer to serious neurological symptoms causing major side effect of antipsychotic drugs. The symptoms include Dystonia Akathisia Pseudo parkinsonism Tardive dyskinesia

5. Dystonia Movement disorder that causes the muscles to contract involuntary either repetitive or twisting movement . Involuntary muscle spasm in face ,arm ,legs and neck occur most often in men Acute muscular rigidity and cramping ,stiff or thick tongue with difficult swallowing , and , in severe cases ,laryngospasm and respiratory difficulty. It occur in the first week treatment in client younger than 40years

6. Dystonia cont … Those receiving high potency drug such as haloperidol and thiothixine Show the following sign and symptoms Torticollis–spasm or stiffness in muscles group (twisted head and neck) Opisthotonus tightening in the entire body with head ,back and arched neck Oculogyric crisis eyes uncontrolled rolling back of the eyes sometimes can be mistaken for seizures activity

7. Cont …. Acute dystonia can be painful and frightening for the client Should be treated as emergency situation because laryngospasm follow this symptoms can be fatal.

8. Treatment of dystonia Immediate treatment with anticholinergic drug eg I/M Benzotropine , or IV diphenhydramine usually bring relief Lowering dose of antipsychotic drug or change antipsychotic drug To stay with the patient or client and offer reassurance and support during the frighting time.

9. Akathisia Inability to remain still Argue to move that you can’t control Feeling of internal and the inability to sit still or rest this cause the patient to discontinue anti psychotic medication the client appear restless or anxious and agitated , often with rigid posture or gait and lack of spontaneous gestures . This disorder common reported by the client as an intense need to move about

10. Treatment of akathisia Give beta blocker Reduce dose of antipsychotic or stop the medication Administer anticholinergic drug

11. Pseudo parkinsonism or drug induced parkinsonism Is the reaction to medication that imitates the symptoms and appearance of Parkinson disease. This condition generally is reversible and stopping medication .

12. Common symptoms resemble for that of Parkinson disease Stiff Stooped posture Mask like face Decreased arm swing Shuffling Festinating gait Drooling Tremor Bradycardia Coarse pill rolling movement of the thumb and finger while at rest

13. Tardive dyskinesia Tardive dyskinesia (TD), a syndrome of permanent involuntary movements, is most commonly caused by the long-term use of conventional antipsychotic drugs . About 20% to 30% of patients on long-term treatment develop symptoms of TD ( Sadock & Sadock , 2008). The pathophysiology is still unclear, and no effective treatment has been approved for general use.

14. ASSESSMENT USING ABNORMAL INVOLUNTARY MOVEMENT SCALE (AIMS) Complete the examination procedure before making ratings. For movement ratings, circle the highest severity observed . Rate movements that occur upon activation one less than those observed spontaneously. Circle movement as well as code number that applies.

15. SCALE CODE Code: 0 = None 1 = Minimal, may be normal 2 = Mild 3 = Moderate 4 = Severe

16. Facial and oral movement 1. Muscles of Facial Expression (e.g., movements of forehead, eyebrows, periorbital area, cheeks, including frowning, blinking, smiling, grimacing) 2. Lips and Perioral Area (e.g., puckering, pouting, smacking) 3. Jaw (e.g., biting, clenching, chewing, mouth opening, lateral movement) 4. Tongue (Rate only increases in movement both in and out of mouth. NOT inability to sustain movement. Darting in and out of mouth.) 0,1,2,3,4

17. Extrimity movement Upper (arms, wrists, hands, fingers) Include choreic movements (i.e., rapid, objectively purposeless, irregular, spontaneous) and athetoid movements (i.e., slow, irregular, complex serpentine). Do not include tremor (i.e., repetitive, regular, rhythmic) 6. Lower (legs, knees, ankles, toes) (e.g., lateral knee movement, foot tapping, heel dropping, foot squirming, inversion and eversion of foot) 7. Neck, shoulders, hips (e.g., rocking, twisting, squirming, pelvic gyrations) 0,1,2,3,4

18. Global jugdement Severity of abnormal movements overall Incapacitation due to abnormal movements Patient’s awareness of abnormal movements (Rate only the client’s report) No awareness Aware, no distress Aware, mild distress Aware, moderate distress Aware, severe distress

19. Dental status Current problems with teeth and/or dentures? . Are dentures usually worn? . Edentia ? . Do movements disappear in sleep? Yes/No

20. NOTE B efore or after completing the Examination Procedure, observe the client unobtrusively, at rest (e.g., in waiting room). The chair to be used in this examination should be a hard, firm one without arms.

21. REFERENCE Psychiatric mental health nursing concept of care in evidence based practice 9 th ED (2018) by mary C At all Stahl’s Essential psychopharmacology 4 th ED by stephan M Stahl’s (2013) Psychiatric mental health nursing 5 th ED (2011) by Shaila.L.Vendebeck