Acute dystonia

A patient with acute dystonia as a result of an antipsychotic injection. She has spasmodic torticollis.

Category:

Education

Tags:

• psychiatry
• acute
• dystonia
• spasmodic
• torticollis

[1petelee]

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'....

[psychiatryteacher]

@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.

[rmcdaniel423]

@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.

[psychiatryteacher]

@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.

[logixish]

This is nothing compared to how bad it can get

[psychiatryteacher]

@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

[makeiteasyable]

ouch. XD

[jacobbis4lovers]

@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.

[winstono75]

Notice the lack of emotional involvement from the psychiatrist.

[Jixejo]

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.

[jberndt88]

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.

[stopthemud]

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.

[websurfin2010]

I had that once. Two hours of absolute hell.

[PsychoticPriest]

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.