Neuroleptic‐Induced Movement Disorders: Deconstructing Extrapyramidal Symptoms

The neurological risks and benefits of atypical neuroleptics have received considerable attention in the medical literature, but there have been few controlled studies examining these risks in elderly patients. Well-designed, longterm prospective studies are needed to identify the safest and most effective treatment regimens for elderly patients, but until these studies are complete, clinicians will need to rely on available studies in making clinical decisions. This article is not an exhaustive systematic review of this topic; rather it is an attempt to integrate recent studies and the author’s clinical experience to provide an approach to understanding the risks of movement disorders associated with the use of antipsychotic medications. NEUROLOGICAL RISKS AND BENEFITS OF ATYPICAL NEUROLEPTICS Within the field of geriatrics, neuroleptics (also called antipsychotics) are among the most commonly prescribed medications. In part, their popularity may be attributed to the growing list of difficult-to-manage psychiatric uses, onand off-label, for which these agents have potential benefit. Also contributing to their increasing usage is the commonly held belief that atypical neuroleptics possess a lower risk of tardive dyskinesia (TD) and other movement disorders, but whether all atypical neuroleptics are indeed safer or less likely to induce movement disorders than typical neuroleptic agents is unclear. Studies examining this issue are conflicting, and assumptions concerning the risks of movement disorders associated with atypical neuroleptics remain speculative. 1‐5