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Background
- Adverse effect of antipsychotics.
- More common with high-potency typical antipsychotics, but can also occur with atypical agents
- Due to antagonism of dopamine-2 receptors in basal ganglia
Clinical Features
- Early-onset syndromes
- hours to days after drug initiation
- reversible
- Acute dystonic reaction
- involuntary, uncoordinated skelatal muscle contraction
- Akathisia
- subjective sensation of intense motor restlessness
- may be misdiagnosed as manifestation of psychiatric disease
- Parkinsonism
- onset weeks to months after starting medication
- similar presentation to Parkinson's disease (e.g. cogwheel rigidity, pill-rolling tremor, shuffling gait, bradykinesia)
- Tardive dyskinesia
- usually irreversible or only partially reversible
- associated with prolonged use of antipsychotics
- stereotyped, repetitive facial movements (e.g. tongue protrusion, grimacing, lip smacking)
Differential Diagnosis
Movement Disorders and Other Abnormal Contractions
Evaluation
Management
- Stop or reduce offending agent
- may need to discuss with psychiatrist to prescribe new medication or for recs on taper
- Acute dystonia, akasthisia, parkinsonism
- Tardive dyskinesia
- may only be partially reversible, so minimize occurrence, stop or reduce offending agent promptly
- Do NOT give anticholinergics, will exacerbate symptoms
Disposition
See Also
External Links
References
