The Maudsley Guidelines on Advanced Prescribing in Psychosis by unknow

Author:unknow
Language: eng
Format: epub
Publisher: John Wiley & Sons, Incorporated
Published: 2019-12-31T00:00:00+00:00

Drugs which have high affinity for muscarinic acetylcholine receptors in the basal ganglia have a reduced propensity for EPSEs. This is the case for thioridazine (now discontinued) and olanzapine.

It was believed that antagonism of serotonin 5HT2a receptors protected against EPSEs, but many of the first‐generation drugs have high affinity for 5HT2a receptors. Also the addition of a pure 5HT2a antagonist to a potent D2 regime has no discernible effect on EPSEs.

Quetiapine and clozapine have low affinity for the dopamine D2 receptor, and relatively higher affinity for muscarinic acetylcholine receptors. The risk of EPSEs are negligible to the extent that clozapine (but probably not quetiapine) is a treatment option in psychosis arising in the context of idiopathic Parkinson's disease [311]. A new agent, pimavanserin, an inverse agonist at 5HT2A and 5HT2C receptors, may have efficacy for psychosis occurring in Parkinson's disease [312, 313], although there has been some controversy [314].

Risperidone, amisulpride, ziprasidone, and asenapine can cause EPSEs.

Aripiprazole, cariprazine, and lurasidone are associated with akathisia.

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