Antipsychotic-induced tardive movement disorders: a series of twelve cases.

BACKGROUND: Prolonged use of antipsychotic drugs (AP) with or without sudden withdrawal as well as high dosage of AP (at least 3 months) may result in a variety of movement disorders such as classical tardive dyskinesia (tongue rolling, lip pouting, trunkal choreiform movements), tardive myoclonus (sudden, brief involuntary jerking), tardive dystonia (tongue protrusion, torticollis, scoliosis, jaw spasm, bruxism, abnormal trunkal posture, or "Pisa syndrome", strong contraction of arm and leg). Patients with severe symptoms often suffer from body pain and fractures of bones due to frequent fallings. They are also accused of "faking" to call attention or they believe that the symptoms are signs of being "cursed or posses in".

OBJECTIVE: To report twelve patients of antipsychotic drug induced tardive movement disorders including tardive dystonia, tardive myoclonus, and tardive Parkinsonism. Patients were incorrectly diagnosed as epilepsy, conversion (pseudo seizure), or hypochondriasis.

RESULTS: In the present series, there were eight men and four women with age ranging from 13 to 72 years. All patients had been taking both typical and atypical antipsychotic drugs for at least one year. Strong involuntary movement disorders, torticollis, scoliosis, body pain, difficulty in swallowing, and aphonia were observed Most patients were thin and anemic. They responded well to diazepam, anticholinergic drug, clonazepam lithium, and antidepressant while antipsychotic drugs were discontinued in most cases. Calcium salt and iron supplement appeared to be useful.

CONCLUSION: Physicians should be aware of these abnormal movement disorders induced by AP drugs to detect early and provide prompt treatment. AP drug should be used cautiously to prevent this iatrogenic effect particularly in high- risk patients.