A 24-year-old man with a recent diagnosis of schizophrenia is admitted to the inpatient psychiatric unit due to worsening paranoia and auditory hallucinations. He is started on high-dose oral haloperidol. As part of patient education, the attending physician discusses the potential adverse extrapyramidal symptoms (EPS) associated with this medication. Arrange the following clinical presentations of EPS in chronological order according to their typical peak onset after initiating the antipsychotic, from earliest (hours/days) to latest (months/years).
- 1Sustained, painful contraction of the neck muscles resulting in a twisted posture
- 2Intense subjective feeling of inner restlessness and a constant compulsion to pace
- 3Development of a slow, shuffling gait, resting tremor, and cogwheel rigidity
- 4Repetitive, involuntary, choreoathetoid movements of the tongue, lips, and face
Cevap
The correct chronological sequence is: Acute dystonia (muscle contractions), followed by Akathisia (restlessness), followed by Drug-induced parkinsonism (rigidity/tremor), and finally Tardive dyskinesia (choreoathetoid movements).
The correct sequence follows the classic chronological pattern of extrapyramidal symptom (EPS) onset following typical antipsychotic initiation (often taught as the 'Rule of 4s'). Acute dystonia, characterized by sustained muscle spasms, occurs earliest (within 4 hours to 4 days). Akathisia, a profound subjective restlessness, follows next (within 4 days to 4 weeks). Drug-induced parkinsonism, marked by bradykinesia and rigidity, occurs third (within 4 weeks to 4 months). Tardive dyskinesia, featuring involuntary choreoathetoid movements, is a late complication occurring after prolonged exposure (4 months to years).
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Anahtar Kavram
The temporal progression of typical antipsychotic-induced extrapyramidal symptoms.