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Phenotypic Profiling of Human Stem Cell-Derived Midbrain Dopaminergic Neurons
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EPS profiles: the atypical antipsychotics are not all the same.

Peter J Weiden1

  • 1Dept of Psychiatry, SUNY Downstate Medical Center in Brooklyn, NY 11203, USA. pweiden@downstate.edu

Journal of Psychiatric Practice
|January 24, 2007
PubMed
Summary

Extrapyramidal side effects (EPS) are harmful and not necessary for antipsychotic efficacy. Newer antipsychotics have lower EPS burden, but careful monitoring is still needed to manage these side effects.

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Area of Science:

  • Psychiatry and Neuroscience
  • Pharmacology
  • Clinical Medicine

Background:

  • Historically, extrapyramidal side effects (EPS) were thought to be necessary for antipsychotic efficacy, linked to the dopamine hypothesis of schizophrenia.
  • The development of clozapine, an antipsychotic with minimal EPS, disproved the necessity of EPS for therapeutic effect.
  • This led to the classification of newer antipsychotics as 'atypical' due to their reduced EPS liability.

Purpose of the Study:

  • To review the current understanding of the relationship between antipsychotic medications and EPS.
  • To compare the EPS liability among second-generation antipsychotics (SGAs).
  • To highlight the clinical relevance of managing EPS even with newer agents.

Main Methods:

  • Review of historical and current literature on antipsychotics and EPS.
  • Analysis of the concept of 'atypicality' in relation to EPS.
  • Comparison of EPS incidence and severity across different SGAs.

Main Results:

  • EPS are harmful and not required for antipsychotic efficacy.
  • While SGAs have a lower EPS burden than older antipsychotics, they can still cause EPS.
  • EPS incidence varies among SGAs, with clozapine and quetiapine having the lowest, and risperidone the highest.

Conclusions:

  • EPS are detrimental and do not contribute to antipsychotic effectiveness.
  • Despite advances, EPS remain a significant clinical challenge with SGAs.
  • Clinicians must recognize and manage EPS, considering agent-specific liability, dosing, and patient vulnerability.