Agents for EPS
- Anticholinergics such as benztropine, trihexyphenidyl, diphenhydramine
- Need to watch for anticholinergic SE particularly in elderly or if taken with other meds with anticholinergic activity ie TCAs
Case
Case
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21 yo AA male with symptoms consistent with schizophrenia is admitted because of profound psychotic sx. He is treatment naïve. You plan to start an antipsychotic what baseline blood work would you obtain?
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Many atypical antipsychotics can cause dyslipidemia, transaminitis and elevated blood sugars and there is a class risk of diabetes unrelated to weight gain so you need the following:
- Fasting lipid profile
- Fasting blood sugar
- Lfts
- CBC
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His labs come back as follows:
- Total Cholesterol:215 HDL:30 LDL:145
- Glucose 88
- Lfts, CBC WNL
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What agent would you like to start?
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Pt has mildly elevated total cholesterol and a low HDL for his age. Would not choose Olanzapine or Quetiapine given risk of dyslipidemia. Risperidone, Ziprasidone or Aripiprazole are good choices.
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You start Risperidone and titrate to 3mg BID (high average dose). He starts to complain that he “feels uncomfortable in my skin like I can’t sit still”. What is likely going on and what are you going to do about it?
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He is likely experiencing akathisia. This is not uncommon with Risperidone. Given he was very ill reducing the dose may not be the best choice so likely treat with an anticholinergic agent or propranolol. You need to treat akathisia because it is associated with an increase risk for suicide!