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Difficulty: EasyPsychopharmacology and Psychological Therapies

A 28-year-old man with a recent diagnosis of schizophrenia is started on haloperidol. His physician is reviewing the adverse effect profile with the patient and his family. Arrange the following extrapyramidal symptoms associated with high-potency typical antipsychotics in chronological order of their characteristic onset, from earliest to latest.

  1. 1Acute dystonia (e.g., torticollis, oculogyric crisis)
  2. 2Akathisia (e.g., severe subjective motor restlessness)
  3. 3Pseudoparkinsonism (e.g., bradykinesia, cogwheel rigidity)
  4. 4Tardive dyskinesia (e.g., involuntary choreoathetoid movements)

Answer

The correct sequence is: Acute dystonia, Akathisia, Pseudoparkinsonism, and Tardive dyskinesia.
The correct chronological order for the onset of extrapyramidal symptoms associated with antipsychotic medications can be remembered using the mnemonic ADAPT: Acute Dystonia (hours to days), Akathisia (days to weeks), Pseudoparkinsonism (weeks to months), and Tardive dyskinesia (months to years).

Step-by-Step Solution

1
Identify the extrapyramidal symptom with the most rapid onset following initiation of a typical antipsychotic.
Acute dystonia appears within hours to days.
It is an acute reaction to sudden dopamine D2 receptor blockade.
2
Determine the symptom that typically follows dystonia in the expected timeline.
Akathisia generally presents within days to weeks.
It represents a subacute response to dopamine blockade and often emerges soon after or concurrently with dystonia resolution.
3
Identify the symptom that emerges in the weeks to months following treatment initiation.
Pseudoparkinsonism is the third in the sequence.
The drug-induced disruption of the nigrostriatal dopamine pathway gradually produces parkinsonian signs over weeks to months.
4
Identify the long-term complication of typical antipsychotic use.
Tardive dyskinesia is the final symptom in the sequence.
It occurs after months to years of exposure due to dopamine receptor upregulation and supersensitivity.

Key Concept

The chronological onset of extrapyramidal symptoms (EPS) due to antipsychotics typically follows the pattern: acute dystonia (hours-days), akathisia (days-weeks), pseudoparkinsonism (weeks-months), and tardive dyskinesia (months-years).
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Topics

Psychopharmacology and Psychological Therapies

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