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Related Experiment Videos

Effects of newer antipsychotics on extrapyramidal function.

Daniel Tarsy1, Ross J Baldessarini, Frank I Tarazi

  • 1Department of Neurology, Harvard Medical School and the Beth Israel Deaconess Medical Center, Boston, Massachusetts 02115, USA. dtarsy@caregroup.harvard.edu

CNS Drugs
|January 5, 2002
PubMed
Summary

Atypical antipsychotics offer reduced risk of extrapyramidal syndromes (EPS), with clozapine and quetiapine showing the best tolerability. Further research is needed for novel antipsychotic agents with improved neurological functioning.

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Area of Science:

  • Pharmacology
  • Neuroscience
  • Psychiatry

Background:

  • Clozapine is a superior antipsychotic with low risk of extrapyramidal syndromes (EPS).
  • Novel atypical antipsychotics were developed based on clozapine's properties.
  • These agents vary in pharmacology and neurological impact, with generally lower EPS risk.

Purpose of the Study:

  • To compare the risk of EPS among atypical antipsychotics.
  • To evaluate the efficacy of atypical antipsychotics in specific neurological conditions.
  • To assess the role of receptor binding in EPS risk.

Main Methods:

  • Comparative analysis of atypical antipsychotic pharmacology and reported EPS risk.
  • Review of clinical data for treatment of Parkinson's disease psychosis, Huntington's disease, and Tourette's syndrome.

Related Experiment Videos

  • Correlation of EPS risk with D2 receptor antagonism and 5-HT2A receptor antagonism.

    • Main Results:

    • A tentative ranking of EPS risk (lowest to highest, excluding akathisia/NMS): clozapine < quetiapine < olanzapine = ziprasidone. Risperidone's risk is dose-dependent.
    • Antipsychotic EPS risk is generally inversely related to D2 receptor potency.
    • High 5-HT2A receptor potency and antimuscarinic activity may limit EPS. Clozapine and quetiapine show potential for Parkinson's disease psychosis.
    • Clozapine may reduce parkinsonian tremor and is useful for tardive dyskinesia.

    Conclusions:

    • Atypical antipsychotics provide only relative avoidance of EPS.
    • Clozapine and potentially quetiapine are well-tolerated options for specific neurological conditions.
    • Continued development of novel antipsychotic agents with improved efficacy and safety is warranted.