What Are the Most Common Drug-Induced Movement Disorders?

View Large Image Figure ViewerDownload Hi-res image Download (PPT)View (PPT) Research is limited regarding the prevalence of drug-induced movement disorders in residents long-term care (LTC) facilities. By contrast, there extensive literature documenting that this population typically at a higher risk for disorders: both median age LTC and increased use pharmacological interventions contribute risk. Drug-induced are more common older patients three to six times who take antipsychotics than those do not (Prim Care Companion J Clin Psychiatry 2004;6[suppl 2]:14–19). Antipsychotics commonly prescribed settings reduce behavioral disturbances, particularly with dementia. Studies have found psychological symptoms affect 65% 90% nursing homes (J Am Geriatrics Society 2019;67:1713–1717), including 78% living dementia (Int Psychogeriatr 2010;22:1025–1039). The antipsychotic antidepressant among adults reported be 27.5% 28.4%, respectively (Am Geriatr 2015;23:S154–S155). disorders, which often referred as extrapyramidal (EPS), include “acute dyskinesias dystonic reactions, tardive dyskinesia, Parkinsonism, akinesia, akathisia, neuroleptic malignant syndrome” (Nurse Pract 1992;17[11]:56,62–64,67). However, dyskinesia (TD), parkinsonism (DIP), dystonia most adults. According Diagnostic Statistical Manual Mental Disorders (5th ed., American Psychiatric Association, 2013), TD defined persistent, medication-induced disorder despite discontinuation or changes medications. “characterized by uncontrollable, abnormal, repetitive movements face, torso, and/or other body parts” (“Tardive Dyskinesia,” National Institute Neurological Stroke, July 25, 2022, http://bit.ly/3Ekc9c8). onset delayed one two years after continued treatment an medication almost never occurs before months 2018;79:16–23). includes facial tics, but it may also parts Cleveland Clinic, Dec. 21, 2021, http://bit.ly/3VcPFAO). Clinicians might observe oral lip smacking, cheek puffing, tongue thrusting; rocking back forth slow writhing torso; finger “like playing piano” foot tapping addition rapid jerky type extremities. up younger (Neuropsychiatr Dis Treat 2019;15:785–794). Primary prevention best means potential TD. This providers should lowest effective dose require agent utilizing shortest amount time necessary (Can 2019 Jun;64(6):388-399). When diagnosed, weigh permanent against exacerbating patient’s psychosis consider reduction causative medication. Treatment prescription vesicular monoamine transporter 2 (VMAT2) inhibitors; however, many cases, these medications cost prohibitive. DIP characterized mimic Parkinson’s disease. days weeks starting medication, on rare occasion will occur several (Neurol Int 2018;10:7877). tremors, muscle rigidity, reduced blinking, drooling, stooped posture, bradykinesia (slowed movements), pill-rolling movements, gait disturbances. Although considered complication use, can triggered antidepressants, calcium channel antagonists, gastrointestinal prokinetics, antiepileptic drugs, drugs (Medicines [Basel] 2021;8[6]:24). Among adults, burdensome. key component symptom recognition identifying factors triggering Discontinuation results marked improvement symptoms. Akathisia neuropsychiatric syndrome “an inability remain still” usually lower half (“Akathisia,” StatPearls, http://bit.ly/3UOalzp). For instance, “the individual cross, uncross, swing, shift from other.” It’s possible symptoms, such feeling irritated, stressed, some cases panicked movement. likely soon moving new potency. Providers causing if feasible prescribe beta blockers, benzodiazepines, low-dose mirtazapine, anticholinergics, vitamins. Dystonia “a nervous system causes uncontrollable contractions” (“Dystonia,” June 20, http://bit.ly/3EFZUIo). “occur[s] shortly initiation drug increase dose; 50% within 48 hours treatment, 5 days” (“Medication-Induced Dystonic Reactions Clinical Presentation,” MedScape, 27, http://bit.ly/3OewKDi). good news is, dystonias mostly reversible when patient taken off drug. medical provider administer parenteral improve 10 30 minutes (“Dystonic Reactions,” 26, http://bit.ly/3hVYz7e). Distinguishing between different requires comprehensive evaluation trained professional. Routine screenings Abnormal Involuntary Movement Scale (AIMS) Dyskinesia Identification System: Condensed User (DISCUS) helpful presence disorder. TD, AIMS scale used conjunction diagnostic criteria, practitioners refer DSM-5 further diagnosis information. Schooler-Kane criteria Extrapyramidal Symptom Rating because comprehensively assesses parkinsonism, dystonia, akathisia (Schizophr Res 2005;76:247–265). It important health perform routine aid early recognition. interfere patients’ quality life decrease their ability complete activities daily living. Due risks detrimental effects cause critical professionals able recognize associated provide appropriate, evidenced-based treatment. Ms. Coniglio president, CMO, founding member Psych360 (http://Psych360.org) Behavioral Health Advisory Council AMDA – PALTC Medicine. Tana Whitt Nurse Practitioner Vice President Affairs Psych360. In addition, she continues holistic evidence based psychiatric mental long term throughout Nort heast Ohio. Dr. Charissa Duffy nurse practitioner regional clinical manager She responsible providing evidence-based managing ongoing expa nsion