Acute extrapyramidal syndromes (EPS) are one of the major limitations to effective neuroleptic treatment. These disorders have both motor (objective) and mental (subjective) aspects, which must be considered in any evaluation and differential diagnosis of treatment‐related side effects. The disorders of akathisia, acute dystonia and parkinsonism have unique features that are best understood in the context of a careful assessment of patient characteristics, drug factors and temporal aspects. Though acute EPS are commonly explained on the basis of dopamine D, receptor antagonism, data from several lines of study raise important questions about this hypothesis. The roles of receptor subtype specificity, brain region selectivity and ratios of different receptor subtype antagonism are discussed. New and novel antipsychotic drugs with low rates of EPS are important clinical advancements that will increase patients' ability to participate in therapy and rehabilitation and thus improve their quality of lif