Match each clinical presentation of a patient receiving antipsychotic therapy with the most appropriate next step in management.
- A 25-year-old man on haloperidol therapy develops a sudden, painful, sustained contraction of his neck muscles and an involuntary upward gaze.Administer intramuscular benztropine or diphenhydramine
- A 30-year-old woman taking risperidone for 4 weeks complains of intense inner restlessness and is observed constantly pacing. Her vital signs are stable.Decrease the antipsychotic dose and cautiously add a beta-blocker such as propranolol
- A 45-year-old man with a 10-year history of fluphenazine treatment is noted to have new-onset, involuntary, repetitive lip-smacking and choreoathetoid finger movements.Taper the offending antipsychotic and consider starting a VMAT2 inhibitor or switching to clozapine
- A 38-year-old woman on olanzapine presents with a temperature of 103.5°F (39.7°C), severe lead-pipe muscle rigidity, tachycardia, diaphoresis, and elevated creatine kinase.Immediately discontinue all antipsychotic medications, initiate supportive care, and consider bromocriptine
Cevap
Match acute dystonia to anticholinergics; akathisia to dose reduction/beta-blockers; tardive dyskinesia to VMAT2 inhibitors/clozapine; and neuroleptic malignant syndrome to antipsychotic discontinuation and supportive care.
Each clinical scenario describes a classic antipsychotic adverse effect with a highly specific treatment pathway. Acute dystonia requires immediate anticholinergic treatment. Akathisia is treated with dose reduction and beta-blockers. Tardive dyskinesia is managed by switching to a medication with a lower liability (e.g., clozapine) or adding a VMAT2 inhibitor. Neuroleptic malignant syndrome is a life-threatening emergency requiring immediate drug cessation, supportive care, and dopamine agonists.
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Anahtar Kavram
Management of Antipsychotic Adverse Effects