Section Free - Video Lectures

07. Antipsychotic-Induced Dystonia: Diagnosis and Management

Published on November 1, 2017 Expired on April 1, 2021

Michael D. Jibson, M.D., Ph.D.

Professor of Psychiatry - University of Michigan

Key Points

Acute dystonic reaction
- Associated with antipsychotics, especially high potency first-generation antipsychotics
- Generally appears early in treatment (90% of cases in the first 4 days)
Drugs used in the acute management of a dystonic reaction:
- Anticholinergic drugs:
  - Benztropine 2 mg IM q 15-30 min (up to 8 mg)
  - Trihexyphenidyl 5 mg IM q 15-30 min (up to 20 mg)
- Antihistamine
  - Diphenhydramine (Benadryl) 50 mg IM q 15-30 min (up to 200 mg)

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References

American Psychiatric Association. Medication-Induced Movement Disorders and Other Adverse Effects of Medication. Diagnostic and Statistical Manual of Mental Disorders, 5th ed (DSM-5), pp. 709-14.
Cloud LJ, Jinnah HA. Treatment strategies for dystonia . Exp Opin Pharmacother (2010) 11: 5-15; doi: 10.1517/14656560903426171.
Van Harten PN, Hoek HW, Kahn RS. Acute Dystonia Induced by Drug Treatment . BMJ (1999) 319: 623-626. Stable URL: http://www.jstor.org/stable/25185698
Pringsheim T, Doja A, Belanger S, Patten S. Treatment recommendations for extrapyramidal side effects associated with second-generation antipsychotic use in children and youth . Paediatr Child Health (2011) 16: 590-98. PMCID: PMC3223903.
Lavonus EJ. First generation (Typical) antipsychotic medication poisoning . In: UpToDate, Sokol N (Ed), UpToDate, Waltham, MA; 2016.
Marder SR, Stroup TS. Pharmacotherapy for schizophrenia: Side effect management. In: UpToDate, Sokol N (Ed), UpToDate, Waltham, MA; 2016.