Paliperidol 2 injection preparations 1 month 3 month -> longest available prep injection out of all anti-psychotics Important side effects long QT syndrome hyperprolactinemia -> most commonly sexual dysfunction palpitations constipation sedation/drowsiness EPS Injectable anti-psychotics 1st gen= flu phenazine, haloperidol 2nd gen = risperidone, aripiprazole, olanzapine, paliperidone For neuroleptic induced acute dystonia use benztropine * Acute ADES Following anti-psychotic * D2 antagonism * sustained painful m. spasm * esp. head & neck & tongue * e.g torticollis, facial grimacing, fixed or deviated stare Physical therapy is merely an adjunctive If a ptx presents with = hyperthermia, m. rigidity, bradyreflexia, these are clinical features of NMNS * most common cause are anti-psychotics e.g. haloperidol * other causes include * anti-emetics such as metoclopramide * increasing dose & switching anti-psychotic are risk factors * may also develop years after continuous therapy & without any associated increases in dose Management discontinuation of med -> most important step transfer to ICU -> Fluid resusc, cardioresp management & lowering of body temp consider giving dop agonists such as bromocriptine &/or dantrolene lab findings leukocytosis ↑ transaminase ↑ CK Consider weaker dopamine-2 antagonism for repetitive lip smacking & choreoathetosis from anti-psych. +D₁ & D₂ - R in the mesolimbic system Fluphenazine (phenothiazine) used for maintenance therapy in ptx with chronic psychosis disorders e.g. schizoaffective ADRs impaired thermoregulation -> hypothermia or hyperthermia -> intolerance of extremes in environmental temperature due to drug effect on hypothalamus inappropriate response overtime liver function tests may become abnormal ↓ hypothyroid hormone release heat ↓ lack of sweating/peripheral vasodilators cold ↑ lack of shivering affects BMR, body temperature, wakefullness, vasomotor tone & em