Physical examinations

Question 1

Pseudo-parkinsonism

Answer 1

• Incidence: 20%
• RFs: more common in older women
• Onset: gradual onset after a few weeks
• Symptoms: akinesia, rigidity and tremor
• Management: reduce dose, change to 2nd gen

Question 2

Acute dystonia

Answer 2

• Incidence: 10%
• RFs: young men, antipsychotic naive
• Onset: few hours
• Symptoms: oculogyric crisis, torticollis, grimacing, trismus, exaggerated posturing
• Management: IM procyclidine 5-10mg

Question 3

Akithisia

Answer 3

• Incidence: 25-50%
• RFs: rapid increase in antipsychotic dose
• Onset: most commonly after day 5
• Symptoms: irritability and restlessness
• Management: procyclidine or propranolol

Question 4

Tardive dyskinesia

Answer 4

• Incidence: 5% at 1 year, 20% of chronic Rx
• Risk factors: elderly women, organic brain disease, long exposure to antipsychotics, affective disorder, Hx of EPSEs
• Symptoms: lip smacking, chewing, tongue protrusion, pelvic thrusting
• Management: change to 2nd gen, vitamin E