Extrapyramidal symptoms

Extrapyramidal Side Effects of Antipsychotics and their management.

1. ExtrapyramidalSymptoms
Dr. Aziz Mohammad
FCPS (Psychiatry)
Asstt; Professor of Psychiatry
KMC/KTH

2. Learning Objectives
Know About:
the Pyramidal and Extrapyramidal Systems of Brain
Anatomy of the Basal Ganglia
A case scenario of Extrapyramidal Side Effect of an
apparently safe medication.
Different Extrapyramidal Symptoms and their
Treatments.

5. Credit: Extrapyramidal and Pyramidal Tracts -Descending Tracts of the Spinal Cord | (Includes
Lesions)
Uploaded to YouTube by: Rhesus Medicine, Feb 1, 2021

6. Basal Ganglia Anatomy

7. ANATOMY
Caudate nucleus
Putamen
Globus pallidus
Substantia nigra
Subthalamic nucleus
Thalamus

8. Basal Ganglia
The “basal ganglia” refers toa group of
subcortical nuclei responsible primarily for
motor control, as well as other roles such as
Motor learning,
Executive functions
Behaviors, and
Emotions
Disruption of the basal ganglia network forms the
basis for several psychiatric and movement
disorders.

9. Case Scenario
A16yearsoldboyisbroughtbyhisworried
parentsatmidnighttothecasualtydepartment
withtwistingofhisnecktoonesideforthepast
30minutes.Hisfatherreportsintakeofsome
syrupfornausea&vomitingadvisedbya
generalpractitionerinthemorning.
What is this condition called and which
medication is responsible for it?
How will you treat this case?

16. Dopaminergic Pathways
By User:Slashme; Patrick J. Lynch; User:Fvasconcellos-self-made; re-use File:Brain bulbar region.svg,
CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=44402772

17. Dopaminergic Pathways

20. Acute Dystonia

21. Causes of Acute Dystonia

25. Treatment of Acute Dystonia
Inj: Procyclidine 10 mg IM stat

26. Treatment of Acute Dystonia
Inj: Benztropine mg IM stat

27. Parkinsonism

28. Switch to Atypical Antipsychotics

29. Treatment of Parkinsonism
Tab: Procyclidine 5mg

32. Neuroleptic Malignant Syndrome

33. Medications associated with
NMS

34. Complications of NMS

35. Management of NMS

36. Tardive Dyskinesia (TD)

37. Tardive Dyskinesia (Cont..)

38. The End