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Atypical Antipsychotics and Extrapyramidal Symptoms

Traditionally, it was thought that atypical antipsychotics were less likely than older antipsychotic medications to cause extrapyramidal symptoms, such as:
  • Rigidity (muscle stiffness)
  • Unusual body or facial movements
  • Persistent muscle spasms
  • Tremors
  • Restlessness
  • A feeling of internal jitteriness.
However, recent research (particularly a study called the "CATIE trial") suggests that older medications may be just as safe and can be tolerated just as well as newer medications, although much controversy still exists on this topic. In the past, older medications were often used at much higher doses than are used currently, which may explain why they appeared to cause more side effects.

Negative Symptoms

Traditionally, it was also thought that newer, atypical antipsychotics were more effective for "negative symptoms" of schizophrenia. Negative symptoms include:
  • Lack of speech
  • "Flat" facial expression or personality
  • Not caring about things (apathy)
  • Lack of pleasure in normally pleasurable activities.
Research seems to support the conclusion that newer medications are better for negative symptoms, although there is significant controversy surrounding this issue as well.

Do They Cause Weight Gain?

Atypical antipsychotics appear to increase the risk of weight gain. Sometimes, this weight gain can be extreme (as much as 75 to 100 pounds or even more). It is not known exactly how or why atypical antipsychotics cause weight gain.
Along with weight gain comes a host of other health risks, such as heart disease, diabetes, or even arthritis. Much research has focused on atypical antipsychotics and diabetes, suggesting a definite link between the two.
Written by/reviewed by:
Last reviewed by: Kristi Monson, PharmD;
Last updated/reviewed:
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