Neuroleptic drug-induced extrapyramidal syndromes and tardive dyskinesia

Neuroleptic (antipsychotic) drug-induced acute extrapyramidal syndromes (EPS) and the late onset tardive dyskinesia (TD) are the major side effects that limit the use of these highly efficacious agents. The appropriate strategy for controlling these side effects is based on the clinical presentations, pathophysiological mechanisms, and contributions of patient and treatment-related risk factors. New information about the mechanisms of action of neuroleptics and the long-term outcome of acute EPS and TD provide valuable insights into these syndromes. The most effective method for maximizing the benefits and minimizing the risks of neuroleptics is to use the lowest effective dose of both neuroleptic and antiEPS drugs in patients who benefit from them. The next major advancement will be to develop new compounds which effectively control psychotic symptoms and are free of the undesirable acute and tardive motor syndromes.