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Drug-induced parkinsonism and the neuroleptic malignant syndrome 

Drug-induced parkinsonism and the neuroleptic malignant syndrome
Chapter:
Drug-induced parkinsonism and the neuroleptic malignant syndrome
Author(s):

Ivan Donaldson

, C. David Marsden

, Susanne A. Schneider

, and Kailash P. Bhatia

DOI:
10.1093/med/9780192619112.003.0507
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date: 22 October 2020

Neuroleptic drugs were introduced into psychiatric practice with the discovery of chlorpromazine in 1952, reserpine in 1954, and haloperidol in 1959. The term neuroleptic literally means ‘that which grips the nerve’. The state of neurolepsis induced by these agents refers to calm indifference without loss of consciousness.

The class of neuroleptic drugs refers to agents used to treat psychotic illness, and the terms antipsychotics, major tranquillizers, and antischizophrenic drugs are often employed.

One characteristic of neuroleptic drugs which distinguishes them from other central depressant drugs is that they are non-sedative, or only weakly sedative, in the doses required to control psychoses. Animals given neuroleptic drugs show reduced motor activity and diminished responses to external stimuli, and have little interest in their environment. They become cataleptic.

Drug-induced parkinsonism (DIP) was recognized 2 years after the introduction of chlorpromazine. In 1954, Steck described parkinsonism in patients treated with chlorpromazine and reserpine. Steck thought that the clinical picture of DIP resembled that of postencephalitic parkinsonism rather than that of typical Parkinson’s disease. He also described the syndrome of akathisia following administration of reserpine, thereby drawing attention to the association between DIP and akathisia. Sicard (1923) had introduced the term akathisia to describe restlessness and the inability to remain lying down or to sit still in patients suffering the sequelae of Von Economo’s encephalitis.

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