Haloperidol toxicity can cause?
Correct Answer: Akathasia
Description: ANSWER: (C) AkathasiaREF: Kaplan 9rh ed p. 1050, Goodman & Gillman 2008 edition page 304HALOPERIDOL TOXICITY:i. Cardiac depressant:QT prolongationTorsades de pointesWeight gain: (little)Sedation: (very little)Anticholinergic side effects: (dry mouth, constipation .paralytic ileus, difficulties in urinating, massive sweating)Adverse neurological syndromes: (Extra pyramidal effects common to most antipsychotic)- ref table belowNEUROLEPTIC INDUCED DISORDERS Acute dystoniaAkathisiaParkinsonismTardive DyskinesiaNeurolepticMalignantSyndrome EarlyIntermediateIntermediateLate (tardive)AnyOWithin 7 days of therapy or| doseWithin 3 monthsof therapy or | doseWithin 3 monthsof therapy or | dose>3-6 months (|dose may unmask dyskinesia)Anytime during therapy(| dose or high potency drugs)I15-20%with typical neuroleptics, 5% with atypical20%30%5% per year of therapy Le. 50% in 10 years0.5%(20-30% mortality)MUnclear, dopamine hypofunction at basal gangliaD2 receptor blockage in mesocortical pathwayD2 receptor blockage at striatumD2 receptor blockage at striatumIdiosyncratic, Relative depletion of dopamine in CNSRFMale , young, mental retardation, h/o ECT, dose elevationElderly,female, mental retardation, Iron deficiency, Affective disorders, dose elevationElderly, Females , dementia, underlying parkinsonism, AIDS, dose elevationElderly, female, h/o ECT, substance abuse, iron deficiency, Mental retardation, Mood disorder, Organic brain damage, Anticholinergic Dose decreaseMale, young, dose elevationSSlow, irregular,continuouscontractions,oculogyricmovements oftongue, torticollis,trismus,abnormal posture, blephero spasmUncontrolledrestlessness,pacing,compulsive foot taping, rocking movement, adversity to stand still, rapid alternation of standing & sittingR = rigidityA = akinesia(mc)T = tremor (atypical-coarse, not pill rolling, late) RABBIT SYNDROME= Lip & perioral tremorsRapid, irregular, continuous or intermittent contractions, orofasciolingual orlimb/trunkal, | by stress activity,Life threateningF = feverE = EncephalopathyV = Vitals unstableE = Elevated CPK,WBCR = RigidityTAnticholinergics: Benzatropine Antihistaminics: DiphenhydramineReduce dose&/or changeantipsychotic.Propranolol=doc, poortreatmentoutcomeAnticholinergics:BenzatropineAntihistaminics:Amantadine,DiphenhydramineReplace by atypical antipsychotic (clozapine is best), lithium & carbamazepine for psychosis, BZD: buspirone for dyskinesiaBromocriptine, lisuride, carbidopa- levodopa,dantrolene sodium, ECTO= Onset, 1= incidence, M= Mechanism, RF= Risk factors, S= Symptoms, T=Treatment
Category:
Psychiatry
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