Management of Adverse Effects: Acute Dystonia

Acute Dystonia

• Acute dystonia is a condition characterized by painful and scary muscle spasms, typically in the head and neck, which can also affect other parts of the body.
• It usually occurs within 12-48 hours of starting a new medication or increasing the dose.
• It mostly affects young men and can be a psychiatric emergency because it can affect breathing, though it is usually not fatal.
• Treatment involves a one-time dose of an antiparkinsonian agent with or without a muscle relaxant like Benztropine 2 mg or Diphenhydramine.
• Diphenhydramine is an antihistamine given as a 50 mg injection, which usually takes effect within 20-30 minutes.
• If the patient's tongue sticks out, they may need to be admitted to the hospital.

Tardive Dyskinesia (TD)

• Tardive dyskinesia is a movement disorder that can develop after using antipsychotic or other medications for a short or long time, or after stopping, changing, or reducing these medications.
• It involves involuntary and repetitive movements of the mouth and face, like chewing or grimacing, as well as rocking and tapping movements.
• Sometimes, it can also affect breathing or speech, though the patient may not be aware of it.
• For diagnosis, TD symptoms must persist for at least a month after stopping the medication.
• Treatment options include:
  • Switching to a different medication like clozapine or olanzapine
  • Using a medication that inhibits a specific transporter in the brain, for example Valbenazine or deutetrabenazine
  • Using a medication like Clonazepam