106 “Random Twitching” - A Case Presentation

Abstract:

Purpose of the study:

To present a case about a 12 year old with a movement disorder to educate the community about an uncommon side effect of a commonly utilized class of psychiatric medications. Simple statement of methods: Patient was seen in the context of a consultation-liaison psychiatry capacity during the first author’s general psychiatry residency. Information was obtained from an electronic medical record and interviews with other physicians that treated the patient. Research about the patient’s supposed diagnosis was conducted using a PubMed + OneSearch searches and articles were obtained under the guidance of a certified hospital librarian.

Results/Discussion:

Withdrawal Emergent Dyskinesia is an uncommon, but debilitating condition that can occur after a rapid discontinuation/dosage change of a neuroleptic. This condition has been documented sparsely in the literature; more literature exists regarding its presence in children than in adults. The condition lasts for 2-3 months and resolves spontaneously in ~90% of cases. The literature that is available suggests (1) avoiding neuroleptic use in children if possible, (2) tapering off antipsychotics slowly, (3) using benzodiazepines and/or beta-blockers to treat symptoms of this condition, and (4) restarting the neuroleptic if symptoms do not improve.

Conclusion:

Withdrawal Emergent Dyskinesia is an uncommon, poorly studied, debilitating condition that can occur after a rapid discontinuation/dosage change of a neuroleptic. Future research efforts could be focused on (a) the prevalence of neuroleptic withdrawal symptoms in both adults and children, (b) the complete neurochemical and neurobiological pathogenesis of WED, and (c) the differences in terms of diagnosis and treatment between dyskinesias associated with both neuroleptic use and/or withdrawal. In addition, the existence of such a condition is yet another reason to reconsider off-label use of neuroleptics to treat behavioral symptoms in the absence of clear psychiatric indications for their use.