Acute Dystonic Reaction

Question 1

What is an acute dystonic reaction?

Answer 1

sustained and often painful muscle contractions affecting any part of the body

Question 2

what is the cause of ADR?

Answer 2

any antipsychotic

Question 3

how long after initiation of a neuroleptic does it occur?

Answer 3

50% within 48hours, 90% within 5 days

Question 4

Which cohort of patients is it most common in?

Answer 4

more common in younger patients and more common in young males

Question 5

what percent of patients will experience ADR after being exposed to neuroleptics?

Answer 5

3-10%

Question 6

what is the aetiology?

Answer 6

• Higher risk in those with prior history or family history of dystonia

Question 7

What are the most common presentations?

Answer 7

• Neck dystonia  30%
• Tongue dystonia  17%
• Jaw dystonia  15%

Question 8

What is more commonly seen in older patients with ADR?

Answer 8

movements are More generalised and more focal in older patients

Question 9

What is the pathophysiology?

Answer 9

UNKNOWN.
However, movements tend to occur when the blood level of medication is dropping.
Patients with liver dysfunctions seem to be more prone to these reactions

Question 10

what is the management?

Answer 10

• Discontinue causative agent
• Intramuscular anticholinergics e.g. Benztropine 2mg IV should be used and then continued orally for 24-48 hrs dependent on half-life of neuroleptic used

Question 11

For those with a proven risk, what can be used as a prophylactic medication?

Answer 11

Amantadine