Felix-Martin Werner and Rafael Coveñas
Schizophrenia is treated by second-generation antipsychotic drugs, which are mostly D2 and 5-HT2A antagonists, and partly by first-generation antipsychotic drugs. Extrapyramidal symptoms, for example dyskinesia, dystonia or parkinsonism can occur as a consequence of the D2 receptor blockade. The functions of classical neurotransmitters in the mesolimbic and extrapyramidal systems are described, and neural networks are added. A D2 receptor blockade leads to a dopaminergic-cholinergic neurotransmitter imbalance in the extrapyramidal system. Pharmacologial options to treat transiently extrapyramidal symptoms are M4 antagonists, GABAA agonists and NMDA antagonists. The development of newer second-generation antipsychotic drug such as aripiprazole and cariprazine reduces the frequency and severeness of extrapyramidal symptoms, because these antipsychotic drugs have a partial agonism at the D2 receptor.
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