MANAGING ANTIPSYCHOTIC-INDUCED ACUTE AND TARDIVE DYSTONIA

Antipsychotic-induced extrapyramidal adverse effects continue to be a serious problem in the treatment of psychotic disorders. While the pat hophysiology of these adverse effects is not well understood, much rec ent research has focused on improving our ability to use available pha rmacotherapy in the most effective and least toxic manner. Acute dysto nic reactions only occur within the first days of antipsychotic treatm ent. They are often distressing and frightening for the patient and ma y even be dangerous. However, they can be effectively prevented or rev ersed with anticholinergics. Furthermore, the growing use of the new a typical antipsychotics will lead to a significant decrease in the rate of acute dystonic reactions.In contrast, tardive dystonia is a long-l asting menace in the course of antipsychotic treatment, for which ther e is no established therapy. Tardive dystonia is sometimes disabling o r disfiguring and, like other tardive disorders, is potentially irreve rsible. Because, in most cases, patients need to continue taking the a ntipsychotic that has caused the adverse effect to prevent relapse of the mental illness, preventive measures are crucial. Antipsychotics sh ould be prescribed only for patients affected by psychotic disorders, when definitely indicated and at the lowest effective dosage. The use of clozapine and other novel antipsychotic agents is also likely to re present an important step in the prevention and treatment of tardive d ystonia. Compared with traditional antipsychotics. most of the new ant ipsychotics are characterised by a low acute extrapyramidal adverse ef fects liability and they also bring the hope of reducing the risk of t ardive disorders. If tardive dystonia has occurred, switching to cloza pine or another atypical antipsychotic and treatment with tetrabenazin e, reserpine and botulinum toxin are possible options.