Identifying signs and symptoms of EPS

Cause of EPS

Legal

Leadership

Cultural Considerations and

Individuals at Risk

Extrapyramidal symptoms are caused by dopamine blockade or depletion in the basal ganglia.

Recognizing

Extrapyramidal Symptoms

Be knowledgeable and teach others to utilize one of the screening tools.

Medication Induced EPS

BE AWARE

Antipsychotic Medications commonly produce EPS as side effect.

There have been many lawsuits filed by patients experiencing TD. The Journal of the American Academy of Psychiatry and the Law and the Journal of Clinical Psychiatry have both printed review articles describing the many legal issues raised. Acording to "Tardive Dyskinesia: Tremors in Law and Medicine," most suits have alleged malpractice but there have also been suits alleging failure to obtain written informed consent, torts violations, failure to monitor, inappropriate reassurance that the TD/EPS symptoms were not drug related, failure to follow standards of care, failure to refer to a neurologist, product liability, etc.

Recognition of Movement Disorders: Extrapyramidal Side Effects and Tardive Dyskinesia. (2004, September 20).

What are they?

Who do they effect?

What are the signs and symptom?

How Is EPS treated?

Treatment of EPS

EPS

Acute Dystonia

Immediately administer an anticholinergic such as diphenhydramne or benztropine IV or IM. Symptoms should resolve in 5-10 minutes.

Akathsia begin patient on an anticholinergics, benzodiazepines or a beta blocker.

Antipsychotic Induced Parkinsonism begin an Anticholinergic.

Tardive Dyskinesia decrease dose of antipsychotics, administer benzodiazepines, initiate a gradual withdrawal of anticholinergics and consider switching to an atypical antipsychotic. For some, nothing can be done.

Signs and Symptoms

Ethical Percpectives

Extrapyramidal Symptoms include Acute dyskinesias and Dystonic Reactions, Tardive Dyskinesia, Parkinsonism, Akinesia, Akathisia, and Neuroleptic Malignant Syndrome.

Acute Dystonia results in severe spasms of the muscles of the tongue, face, neck involuntary upward deviation of the eyes, arching forward of the trunk while the head and legs are thrust bakward.

Akathisia is displayed by pacing, squirming, inability to sit still, uncontrollable need to be moving.

Antipsychotic-Induced Parkinsonism results in tremors, rigidity, shuffling gait, masklike facies, drooling, cogwheeling, stooped posture, bradyknesia,

Tardive dyskinesia is displayed by involuntary, unusual movements of the tongue and face, lip smacking movements, may include involuntary movements.

Doing good and preventing harm frequently can create an ethical dilemma when treating with a medication which can produce EPS and possibly lead to Tardive Dyskinesia.

Nurses must weigh the benefits of decreasing or alleviating the symptoms being treated verse the risks of developing side effect. Further needing to readily identify and treat should side effects occur.

Quality and Safety

To avoid EPS and potentially irreversible TD, neuroleptics must be used at the lowest possible doses, for the shortest possible duration, only when clearly indicated and when there is no safer alternative. Patients should be monitored closely and frequently for emerging symptoms using standardized movement rating scales. Possible side effects should be fully disclosed via written informed consent documents and the providers should initiate an ongoing dialog about this topic with the patient. The providers should consider alerting family members since they often become aware of movement disorders before the patient does.

Recognition of Movement Disorders: Extrapyramidal Side Effects and Tardive Dyskinesia. (2004, September 20).

Non Antipsychotic Medications

Identifying Signs and Symptoms of EPS

by Kelli Puhnaty, BSN, RN BC

Less recognized is that extrapyramidal symptoms are also associated with certain non-antipsychotic agent such as antidepressants, lithium, various anticonvulsants, antiemetics and rarely oral-contraceptive agents.