Ever prescribed an antipsychotic and worried about movement disorders? Or inherited a patient on Cogentin and thought, “Is this really the best approach?”
Like many mental health providers, you’ve probably seen extrapyramidal symptoms (EPS) or tardive dyskinesia (TD) in practice—but you might feel uncertain about how to manage these movement disorders. And let’s be honest: most of us didn’t get a deep education on drug-induced movement disorders in school.
That’s a problem—because mismanaging these conditions can directly impact patient outcomes.
TD Is More Common Than You Think
We tend to think of TD as rare, but current research tells another story. One study shows:
📊 13% risk of TD with atypical antipsychotics
📊 32% risk with typical antipsychotics
And it’s not just an issue when treating schizophrenia—we’re seeing TD across a wide spectrum of psychiatric conditions, including mood disorders.
Why Cogentin Might Be Making Things Worse
The “go-to” fix for movement symptoms has long been benztropine (Cogentin). But here’s the problem:
❌ Cogentin does not help TD.
❌ In fact, it can make TD worse—while also causing anticholinergic side effects.
It’s time to stop universally prescribing Cogentin to any patient prescribed an antipsychotic agent. Instead, we need to target the actual condition.
Clinical Pearls for Managing TD and EPS
According to APA guideline recommendations, here’s what PMHNPs need to keep in mind:
✅ VMAT2 inhibitors like deutetrabenazine (Austedo XR) and valbenazine (Ingrezza) are first-line treatments for moderate to severe TD
✅ These same medications may worsen medication-induced parkinsonism
✅ Anticholinergics may worsen TD rather than improve it
✅ Each movement disorder needs a tailored treatment plan—not a one-size-fits-all solution
Know When to Refer
Let’s be honest—movement disorders are complex, and most PMHNPs aren’t trained neurologists. Sometimes, the best clinical decision is a referral or second opinion from a movement disorder specialist.
Still, knowing that something as small as a little Cogentin could worsen TD gives us the power to practice with more caution and higher quality.
Want a More Structured Approach?
If you want to build confidence treating mental health conditions with clear, evidence-informed strategies, join me for a free training:
🎓 Mastering Mental Health – Free Training
You’ll walk away with a step-by-step framework to guide your decisions—so you don’t have to rely on guesswork or outdated habits.