What are common extrapyramidal symptoms and how are they managed?

• A. Acute dystonia, akathisia, parkinsonism, tardive dyskinesia; managed with dose adjustment, anticholinergics, beta-blockers for akathisia, or switching antipsychotics.
• B. Acute dystonia and akathisia only; managed with dose reduction.
• C. Tardive dyskinesia only; managed with antipsychotic switch.
• D. EPS cannot be managed and require stopping all antipsychotics.

Answer: (C)

Extrapyramidal symptoms come from dopamine blockade in the brain’s motor pathways, so the four classic movement side effects to recognize are acute dystonia, akathisia, parkinsonism, and tardive dyskinesia. The best answer reflects all four syndromes and pairs them with appropriate management for each. Acute dystonia is treated quickly with an anticholinergic such as benztropine or diphenhydramine. Parkinsonism often improves by reducing the antipsychotic dose or adding an anticholinergic. Akathisia is typically managed by lowering the dose or switching to a drug with lower EPS risk, with beta-blockers like propranolol sometimes helping. Tardive dyskinesia is primarily addressed by reducing exposure or switching to a different antipsychotic with lower TD risk, and VMAT2 inhibitors can be used when TD is persistent.

Other options miss aspects of this spectrum or oversimplify management (for example, focusing on only two symptoms or claiming EPS cannot be managed). Understanding the full range and matching interventions to each symptom is essential for effectively handling these medication-induced effects.