What are the potential side effects of antipsychotic medications used in the management of delusional disorder?

Antipsychotic medications used in the management of delusional disorder can cause a range of potential side effects that require careful monitoring and management. Common side effects include extrapyramidal symptoms such as tremors, rigidity, bradykinesia, and akathisia, which are more frequently associated with first-generation antipsychotics but can also occur with second-generation agents Peluso et al. 2012. Metabolic side effects are significant and include weight gain, increased blood glucose or HbA1c, and dyslipidaemia, necessitating regular monitoring of weight, blood glucose, and lipid profiles as recommended by UK guidelines NICE CG185,NICE CG178. Cardiovascular risks such as hypertension, arrhythmias, and other vascular effects may also arise, warranting baseline and ongoing cardiovascular assessments including pulse, blood pressure, and ECG when indicated (Kahl et al., 2018; NICE CG185,NICE CG178). Anticholinergic effects, which can impair cognitive function and mobility especially in older adults, are also a concern and should be considered when prescribing NICE CG185. Hyperprolactinaemia is another potential side effect, with recommendations to monitor prolactin levels annually or more frequently if symptoms develop NICE NG181. Additionally, sedation, orthostatic hypotension, and gastrointestinal disturbances may occur. The risk of side effects should be discussed with the patient prior to initiation, with doses started low and titrated carefully within licensed ranges, and treatment should be considered an individual therapeutic trial with ongoing assessment of benefits and harms NICE CG185,NICE CG178. Monitoring should continue regularly throughout treatment to detect side effects early and adjust therapy accordingly NICE CG185,NICE CG178.