In tandem with the benefits of antipsychotic medications are significant risks associated with
their use. These risks are primarily acute and chronic neurological adverse effects, such as
parkinsonism, akathisia, dystonia, and tardive dyskinesia, that can range in intensity from mild
to severe. Newer atypical antipsychotic agents do not cause agranulocytosis, and usually cause
fewer parkinsonian symptoms than the typical agents when given in doses at the lower end of their
therapeutic range. Side effects include (1) acute dystonic
reaction (2% of patients, onset within hours); (2) drug-induced Parkinsonism (20-40% of patients,
onset 5-30 days); (3) akathisia (20% of patients, onset 5-60 days); (4) tardive dyskinesia (20%
of patients, onset 3 months to years); (5) neuroleptic malignant syndrome (0.5-1% of patients,
mortality around 20%); (6) metabolic impairments among which weight gain (15% of patients within
the first weeks of treatment — 50% of patients in the long term) and diabetis mellitus
(6% of patients) are prominent.
Acute side effects of antipsychotics, generally referred to as extrapyramidal side effects, are
often quite uncomfortable for patients and may compromise compliance with an otherwise beneficial
antipsychotic medication regimen. Extrapyramidal effects by themselves have been related to a
poor outcome, a compromised compliance, secondary negative symptoms, cognitive parkinsonism, and
depression.
Antipsychotic-induced extrapyramidal effects, along with the conditions under which they occur in
the individual patient, are insufficiently understood, and display considerable ethnic variation.
Given current knowledge, it is not possible to make any predictions of whether a particular patient
will develop side effects — and to what extent — under a particular antipsychotic
treatment. Clearly, the assessment of ethnicity-specific predictors by means of objective laboratory
methods would greatly improve antipsychotic drug therapies and ultimately lead to a more personalized
and better tolerable medicine.
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