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This case report presents a 17.5-year-old female adolescent who developed extrapyramidal symptoms (EPS) following the addition of fluphenazine to her therapy, which had been modified due to deteriorating psychiatric symptoms. After the resolution of the EPS, the patient developed anticholinergic syndrome within a few days. Pharmacogenetic testing showed genetic variations associated with modified drug and dopamine metabolism, which may have contributed to her increased predisposition to drug adverse effects. This case highlights the complexity of psychopharmacological management in adolescents with multidimensional symptomatology and emphasizes the potential value of integrating pharmacogenetic data to guide optimal treatment strategies.<\/jats:p>","DOI":"10.11613\/bm.2026.020902","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T08:11:07Z","timestamp":1775722267000},"page":"361-368","source":"Crossref","is-referenced-by-count":1,"title":["Extrapyramidal and anticholinergic reactions in an adolescent patient: a case for pharmacogenetic consideration"],"prefix":"10.11613","volume":"36","author":[{"given":"Nada","family":"Bo\u017eina","sequence":"first","affiliation":[{"name":"School of Medicine, University of Zagreb, Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maja","family":"\u017divkovi\u0107","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Zagreb, Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan","family":"Begovac","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, University Hospital Centre Zagreb, Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lana","family":"Ganoci","sequence":"additional","affiliation":[{"name":"Division of Pharmacogenomics and Therapy Individualization, Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Livija","family":"\u0160imi\u010devi\u0107","sequence":"additional","affiliation":[{"name":"Division of Pharmacogenomics and Therapy Individualization, Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Okru\u017enik \u017delali\u0107","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, University Hospital Centre Zagreb, Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivana","family":"Stefanovi\u0107","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, University Hospital Centre Zagreb, Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris","family":"\u017duni\u0107 I\u0161asegi","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, University Hospital Centre Zagreb, Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4885","published-online":{"date-parts":[[2026,6,15]]},"reference":[{"key":"key20260409081103_r1","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1111\/bcp.12267","article-title":"Paediatric pharmacokinetics: key considerations.","volume":"79","author":"Batchelor","year":"2015","journal-title":"Br J Clin Pharmacol"},{"key":"key20260409081103_r2"},{"key":"key20260409081103_r3","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1080\/17425255.2023.2252340","article-title":"Clinical pharmacokinetics of antipsychotics in pediatric populations: a scoping review focusing on dosing regimen.","volume":"19","author":"Liang","year":"2023","journal-title":"Expert Opin Drug Metab Toxicol"},{"key":"key20260409081103_r4","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1089\/cap.2023.0074","article-title":"Pharmacogenetics in Child and Adolescent Psychiatry: Background and Evidence-Based Clinical Applications.","volume":"34","author":"Malik","year":"2024","journal-title":"J Child Adolesc Psychopharmacol"},{"key":"key20260409081103_r5","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1097\/JCP.0b013e31829abec9","article-title":"The Association Study of Polymorphisms in DAT, DRD2, and COMT Genes and Acute Extrapyramidal Adverse Effects in Male Schizophrenic Patients Treated With Haloperidol.","volume":"33","author":"Zivkovi\u0107","year":"2013","journal-title":"J Clin Psychopharmacol"},{"key":"key20260409081103_r6","unstructured":"Gene-specific Information Tables for CYP2C9 [Internet]. 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