A 25 year old man with a psychotic illness, was treated with haloperido130mg/day. On the third day, he developed pacing, and inability to sit still in one place. The medication likely to be helpful is –
**Core Concept**
Haloperidol, a typical antipsychotic, can cause extrapyramidal side effects (EPS) due to its blockade of dopamine D2 receptors in the nigrostriatal pathway, leading to motor symptoms such as akathisia.
**Why the Correct Answer is Right**
Akathisia is characterized by subjective feelings of restlessness and objective signs of agitation, such as pacing and inability to sit still. The likely cause in this case is haloperidol-induced akathisia, which is a common side effect of typical antipsychotics. Treatment of akathisia typically involves switching to an atypical antipsychotic, which has a lower risk of EPS, or adding a beta-blocker such as propranolol, which can help alleviate symptoms.
**Why Each Wrong Option is Incorrect**
* **Option A:** This option is not specified, but a common wrong choice would be a medication that blocks serotonin receptors, such as an SSRI. However, SSRIs are not typically used to treat akathisia.
* **Option B:** A typical antipsychotic such as haloperidol is the likely culprit, not the solution. Adding more haloperidol would only exacerbate the EPS.
* **Option C:** This option is also not specified, but a wrong choice might be a medication that blocks dopamine receptors in a different way, such as a dopamine agonist. However, dopamine agonists would worsen the EPS.
**Clinical Pearl / High-Yield Fact**
Atypical antipsychotics, such as olanzapine or risperidone, have a lower risk of EPS compared to typical antipsychotics like haloperidol. This is because they have a lower affinity for dopamine D2 receptors and a higher affinity for serotonin 5-HT2 receptors.
**Correct Answer:** B. Beta-blockers such as propranolol are often used to treat akathisia.