This happened to me 30hrs after taking phenothiazines. I was very scared, I work in a clinic so they gave me Epinephrine. I used to work as an EMT so I tried to tell them Epinephrine was pointless, I was having muscle spasms, but I couldn't talk. They treated me with Diphenhydramine. Very painful and scary situation. This is a foriegn subject to me as an EMT and the Paramadics when they showed up. Maybe this should be put as a major part of education in emergency medical training.
My spasmodic dystonia started gradually and maximized over a six month period. That's how the medical texts explain the onset. This onset seems odd. I would also say that from what i have read anti-psychotic meds are not the primary cause. no one knows what the exact cause is.
When I was 13 I was in a mental hospital and was given high doses of risperidone. It gave me acute dystonia. the nurses thought I was making it up so when my plea's went unanswered I had a fit and was quickly restrained* to my bed. I was left in agonizing pain for hours until a doctor came by and realizing what It was gave me a couple pills of benadryl and the symptoms soon went away. I had to deal with PTSD for years after that and it took years for me to trust hospital again.
Doc, I know you've heard of tardive dystonia and the fact that it can be chronic and even lifelong. How come no mention of botox? Do you ever refer your dystonia-afflicted patients to a neurologist? I mean, hasn't dystonia been shown to be a neurological disorder and NOT a psychiatric disturbance? I have CD/ST, and, while there's definitely a psychological component involved (as there is with many disorders of the brain), it was long ago discovered to be a movement disorder. I'm just sayin'....
@1petelee All the points you make are relevant. This case is a reaction to an antipsychotic hence the acute treatment with an antimuscarinic agent. Dystonia not arising from a response to medication would be referred to an neurologist as you're quite right it is not a psychiatric disorder.
@psychiatryteacher I am an undergrad student working toward a degree as a P.A. You mentioned the use of an antimuscarinic agent for a case like this. Correct me if I'm wrong, but I thought skeletal muscles (like sternocleidomastoid) had nicotinic ACh receptors, while parasympathetic smooth muscle (like the CV system) had muscarinic. How does an antimuscarinic work for this condition? I must be missing something, because this seems counterintuitive to me. Perhaps my understanding is wrong.
@rmcdaniel423 Sorry it's taken me so long to respond. Acute dystonia as a result of antipsychotics is caused by blockade of nigrostriatal D2 receptors. This leads to an excess excess striatal cholinergic output, hence the role of antimuscarinic drugs. The action is therefore central rather than peripheral.
@1petelee Well, maybe she's having a reaction to her medication and thought she should let her Psychiatrist know so they can either take her off it or lower the dose. Many anti psychotic medications cause Tardive Dystonia and other movement disorders. I don't know how they cause it, but I think it's from blocking a certain chemical in the brain that is essential for movement. If this chemical is blocked by these drugs, then the patient will struggle with involuntary muscle movements.
@logixish Couldn't agree more. It's always a delicate balance in generating teaching videos between showing what can be useful to teach and what is the more dramatic/extreme
when i had this i couldnt move a damn thing. it started with my neck but then i couldnt talk or move after awhile. until they shot me up with an iv of benadryl.
the effects afterward are far worse than the reaction though. i had mini-strokes, memory loss, hallucinations, uncontrolled thoughts, etc. its like your brain is unraveling and something inside of you knows whats going on but is compltely helpless to interfere.
Why is it that a further course of benztropine is required for approximately a further month? I know this will reduce the likelihood of furrther dystonic reactions but why is the cut off set at one month?
There isn't typically a time limit on the use of antimuscarinics. Certainly in clinical practice patients may be on la long term antimuscarinic. Ideally one would aim to be using doses of medication that don't result in acute dystonias or other extra-pyramidal side effects.
You're quite right. Benztropine, like procyclidine, is an antimuscarinic drug which you'll note is what I recommended in an earlier reply to a comment posted. At around 1m 20s into the video the psychiatrist refers, albeit in vague terms, to this.
There is absolutely no evidence that chiropractic 'treatment' has any value in acute dystonia caused by an antipsychotic. Unfortunately many unsubstantiated claims are made for chiropractic treatments and when challenged the British Chiropractic Association has resorted to legal suit.
some research definitely should be put towards the effect od osteopathic / chiropractic cervical manipulation and this disorder. is there any out there?
Recently I saw an article about children with severe weight gain related to the consume of anti psychotic drugs. Being more specific atypical antipsychotics (like olanzapine) are more commonly related to weight gain. If interested in other interesting videos on medical news, visit Symposier site.
ouch. XD
makeiteasyable 2 months ago
Notice the lack of emotional involvement from the psychiatrist.
winstono75 7 months ago
God that place looks creepy, it has no soul,and the doctor is scary... much like a real psych ward then...
dystonia is very very painful, i've had it many times from antipsychotics if I didn't have procycladine. Jesus I hate what psychiatry has done to me.
Jixejo 7 months ago 2
This happened to me 30hrs after taking phenothiazines. I was very scared, I work in a clinic so they gave me Epinephrine. I used to work as an EMT so I tried to tell them Epinephrine was pointless, I was having muscle spasms, but I couldn't talk. They treated me with Diphenhydramine. Very painful and scary situation. This is a foriegn subject to me as an EMT and the Paramadics when they showed up. Maybe this should be put as a major part of education in emergency medical training.
jberndt88 1 year ago
My spasmodic dystonia started gradually and maximized over a six month period. That's how the medical texts explain the onset. This onset seems odd. I would also say that from what i have read anti-psychotic meds are not the primary cause. no one knows what the exact cause is.
stopthemud 1 year ago
I had that once. Two hours of absolute hell.
websurfin2010 1 year ago
When I was 13 I was in a mental hospital and was given high doses of risperidone. It gave me acute dystonia. the nurses thought I was making it up so when my plea's went unanswered I had a fit and was quickly restrained* to my bed. I was left in agonizing pain for hours until a doctor came by and realizing what It was gave me a couple pills of benadryl and the symptoms soon went away. I had to deal with PTSD for years after that and it took years for me to trust hospital again.
PsychoticPriest 1 year ago
Doc, I know you've heard of tardive dystonia and the fact that it can be chronic and even lifelong. How come no mention of botox? Do you ever refer your dystonia-afflicted patients to a neurologist? I mean, hasn't dystonia been shown to be a neurological disorder and NOT a psychiatric disturbance? I have CD/ST, and, while there's definitely a psychological component involved (as there is with many disorders of the brain), it was long ago discovered to be a movement disorder. I'm just sayin'....
1petelee 1 year ago
@1petelee All the points you make are relevant. This case is a reaction to an antipsychotic hence the acute treatment with an antimuscarinic agent. Dystonia not arising from a response to medication would be referred to an neurologist as you're quite right it is not a psychiatric disorder.
psychiatryteacher 1 year ago
@psychiatryteacher I am an undergrad student working toward a degree as a P.A. You mentioned the use of an antimuscarinic agent for a case like this. Correct me if I'm wrong, but I thought skeletal muscles (like sternocleidomastoid) had nicotinic ACh receptors, while parasympathetic smooth muscle (like the CV system) had muscarinic. How does an antimuscarinic work for this condition? I must be missing something, because this seems counterintuitive to me. Perhaps my understanding is wrong.
rmcdaniel423 1 year ago
@rmcdaniel423 Sorry it's taken me so long to respond. Acute dystonia as a result of antipsychotics is caused by blockade of nigrostriatal D2 receptors. This leads to an excess excess striatal cholinergic output, hence the role of antimuscarinic drugs. The action is therefore central rather than peripheral.
psychiatryteacher 1 year ago
@1petelee Well, maybe she's having a reaction to her medication and thought she should let her Psychiatrist know so they can either take her off it or lower the dose. Many anti psychotic medications cause Tardive Dystonia and other movement disorders. I don't know how they cause it, but I think it's from blocking a certain chemical in the brain that is essential for movement. If this chemical is blocked by these drugs, then the patient will struggle with involuntary muscle movements.
jacobbis4lovers 3 months ago
The doctor's really CUTE!!
band3kafsh 1 year ago
This is nothing compared to how bad it can get
logixish 1 year ago
@logixish Couldn't agree more. It's always a delicate balance in generating teaching videos between showing what can be useful to teach and what is the more dramatic/extreme
psychiatryteacher 1 year ago
when i had this i couldnt move a damn thing. it started with my neck but then i couldnt talk or move after awhile. until they shot me up with an iv of benadryl.
the effects afterward are far worse than the reaction though. i had mini-strokes, memory loss, hallucinations, uncontrolled thoughts, etc. its like your brain is unraveling and something inside of you knows whats going on but is compltely helpless to interfere.
suckbar69 1 year ago
Why is it that a further course of benztropine is required for approximately a further month? I know this will reduce the likelihood of furrther dystonic reactions but why is the cut off set at one month?
SuperRabidrabbit 2 years ago
There isn't typically a time limit on the use of antimuscarinics. Certainly in clinical practice patients may be on la long term antimuscarinic. Ideally one would aim to be using doses of medication that don't result in acute dystonias or other extra-pyramidal side effects.
psychiatryteacher 2 years ago
Isn't a shot of benztropine useful in this scenario?
SuperRabidrabbit 2 years ago
You're quite right. Benztropine, like procyclidine, is an antimuscarinic drug which you'll note is what I recommended in an earlier reply to a comment posted. At around 1m 20s into the video the psychiatrist refers, albeit in vague terms, to this.
psychiatryteacher 2 years ago
There is absolutely no evidence that chiropractic 'treatment' has any value in acute dystonia caused by an antipsychotic. Unfortunately many unsubstantiated claims are made for chiropractic treatments and when challenged the British Chiropractic Association has resorted to legal suit.
psychiatryteacher 2 years ago
chiropractic can help
joeylodes 2 years ago
Actually it can't!
The treatment for this disorder is an antimuscarinic medication.
psychiatryteacher 2 years ago
some research definitely should be put towards the effect od osteopathic / chiropractic cervical manipulation and this disorder. is there any out there?
joeylodes 2 years ago
Recently I saw an article about children with severe weight gain related to the consume of anti psychotic drugs. Being more specific atypical antipsychotics (like olanzapine) are more commonly related to weight gain. If interested in other interesting videos on medical news, visit Symposier site.
MrSymposier 2 years ago