Antipsychotics are a group of drugs used in the management of schizophrenia and other forms of psychosis, mania and agitation. They are usually divided into typical and atypical antipsychotics. The atypical antipsychotics were developed due to the problematic extrapyramidal side-effects which are associated with the first generation of typical antipsychotics.

Typical antipsychotics

Extrapyramidal side-effects (EPSEs)

• Parkinsonism
• acute dystonia
  • sustained muscle contraction (e.g. torticollis, oculogyric crisis)
  • may be managed with procyclidine
• akathisia (severe restlessness)
• tardive dyskinesia (late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw)

The Medicines and Healthcare products Regulatory Agency has issued specific warnings when antipsychotics are used in elderly patients:

• increased risk of stroke
• increased risk of venous thromboembolism

Other side-effects

• antimuscarinic: dry mouth, blurred vision, urinary retention, constipation
• sedation, weight gain
• raised prolactin
  • may result in galactorrhoea
  • due to inhibition of the dopaminergic tuberoinfundibular pathway
• impaired glucose tolerance
• neuroleptic malignant syndrome: pyrexia, muscle stiffness