‹ All explainersAntipsychotic side effects: which movement problem, and when?Extrapyramidal side effects arrive on a timeline — know the order.Select any card for the reasoning, what to watch for and an exam tip.HoursDaysWeeksMonths–yearsWithin hoursAcute dystoniaSudden, uncontrolled muscle spasm — the neck twisting or the eyes rolling upMore common in young malesWhy? →Hours to weeksAkathisiaAn inner restlessness — can’t sit still, pacesEasily mistaken for worsening psychotic agitationWhy? →Gradual onsetParkinsonismTremor, slowness of movement (bradykinesia), stiffnessMore common in elderly females and after a strokeWhy? →Long-term treatmentTardive dyskinesiaInvoluntary movements of the lips, tongue, face and jawCan persist after stopping — sometimes irreversibleWhy? →Also watch forWeight gain & diabetesAll antipsychotics may cause weight gain — clozapine and olanzapine commonlySecond-generation drugs are linked to glucose intoleranceRaised prolactinDopamine normally holds prolactin release in checkMost likely with risperidone, amisulpride, sulpiride and first-generation drugsHeart rhythm & blood pressureQT prolongation — the risk rises above maximum doses and with combinationsPostural hypotension when starting — falls in older peopleSedationDrowsiness is a common side-effect of antipsychoticsHow sedating varies by drug — haloperidol is one of the less sedatingEmergencyNeuroleptic malignant syndromeHyperthermia, muscle rigidity, fluctuating consciousnessFever, fast heart rate, unstable blood pressure, sweatingKey takeawayDystonia within hours, akathisia over hours to weeks, parkinsonism gradually, tardive dyskinesia after long-term use.