Neurological Side Effects of Antipsychotic Drugs
Acute dystonia - Spasm of muscles of tongue, face, neck, back
 • Time: 1-5 days. Young, antipsychotic, naive patients at highest risk
 • Tx: Antiparkinsonian agents are diagnostic and curative
Akathisia - Subjective and objective restlessness; not anxiety or "agitation"
 • Time: 5-60 days
 • Tx: Reduce dose or change drug; clonazepam, propranolol more effective than antiparkinsonian agents
Parkinsonism - Bradykinesia, rigidity, variable tremor, mask facies, shuffling gait
 • Time: 5-30 days. Elderly at greatest risk
 • Tx: Dose reduction; change medication; antiparkinsonian agent
Neuroleptic malignant syndrome - Extreme rigidity, fever, unstable blood pressure, myoglobinemia; can be fatal
 • Time: weeks-months. Can persist for days after stopping antipsychotic
 • Tx: Stop antipsychotic immediately; supportive care; dantrolene and bromocriptine
Perioral tremor ("rabbit syndrome") - Perioral tremor (may be a late variant of parkinsonism)
 • Time: months or years of treatment
 • Tx: Antiparkinsonian agents often help
Tardive dyskinesia - Orofacial dyskinesia; rarely widespread choreoathetosis or dystonia
 • Time: months or years of treatment.
 • Tx: May be reversible with early recognition and drug discontinuation VMAT2 inhibitors valbenazine and deutetrabenazine are FDA-approved for TD

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