Movement disorders

Question 1

When does acute dystonia typically occur after starting an antipsychotic?

Answer 1

Within hours to 5 days

Question 2

Name 3 classic features of acute dystonia.

Answer 2

Oculogyric crisis

Torticollis

Jaw/neck muscle spasm

Question 3

What is first-line treatment for acute dystonia?

Answer 3

IM/IV benztropine or diphenhydramine

Question 4

What is akathisia?

Answer 4

Subjective inner restlessness with inability to sit still

Question 5

When does akathisia usually develop?

Answer 5

Days to weeks after starting/increasing dose

Question 6

What is first-line treatment for akathisia?

Answer 6

Propranolol
[Other acceptable: reduce dose, benzodiazepine]

Question 7

When does antipsychotic-induced parkinsonism occur?

Answer 7

Weeks to months after initiation

Question 8

Name 3 features of drug-induced parkinsonism.

Answer 8

Bradykinesia

Rigidity

Resting tremor

Question 9

What is first-line treatment for antipsychotic-induced parkinsonism?

Answer 9

Reduce dose or switch to atypical antipsychotic
[Other acceptable: benztropine]

Question 10

When does tardive dyskinesia occur?

Answer 10

Months to years after exposure

Question 11

What are the characteristic movements in tardive dyskinesia? (1)

Answer 11

Orofacial choreiform movements (lip smacking, tongue protrusion)

Question 12

First-line management for tardive dyskinesia

Answer 12

Discontinue or switch antipsychotic
Consider VMAT2 inhibitor (e.g., valbenazine)

Question 13

Name the 4 classic features of NMS

Answer 13

Hyperthermia

“Lead-pipe” rigidity

Autonomic instability

Altered mental status

Question 14

What key lab abnormality is seen in NMS?

Answer 14

Elevated CK

Question 15

What is immediate management for NMS? (3)

Answer 15

Stop antipsychotic + supportive care
[Other acceptable: dantrolene, bromocriptine]