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Volume 32 number 4 airport rev.p65

Haloperidol Induced Dystonia
Syed O. Quadri, M.D.
Cecilia De Vargas, M.D.
Adharsh P. Sahadevan, M.D.
SCIENTIFIC REVIEW
Lina Maria Reyes, M.D.
CASE REPORT
BACKGROUND INFORMATION
side which this patient suffered from. Haloperidol interferes Haloperidol is a typical antipsychotic used in the treatment with the effects of neurotransmitters in the brain which are of Schizophrenia, and more acutely in the treatment of acute the chemical messengers that nerves manufacture and re- psychosis and delirium. It is in the butyrophenone class of lease to communicate with one another. It blocks receptors antipsychotic medications and has pharmacological effects for the neurotransmitters (specially the Dopamine and Sero- similar to the phenothiazines. Haloperidol is the first of the tonin Type II receptors) on the nerves. As a result, the nerves butyrophenone series of major antipsychotics.
are not “activated” by the neurotransmitters released by othernerves. The treatment of dystonia is usually straightforward CASE PRESENTATION
and almost always affective. Intramuscular administration of This is a 17 year old Latin American male with the diagnosis anticholinergics like Beztropine or Diphenhydramine or the of Substance induced mood disorder with psychosis Vs Bi- use of antihistamines like Promethazine is usually very effec- polar I Disorder, , severe with psychotic features. The patient tive. In some cases Benzodiazepines are very helpful to treat had been transferred to the psychiatric unit after being medi- cated twice with Haloperidol because of physical aggressiontowards others from a local medical facility. This is his first This patient gives a picture of Haloperidol causing physical admission to a psychiatric hospital. The patient had been and emotional distress due to its severe side effects. Fortu- using Marijuana and Methamphetamines for more than a year.
nately, it is very simple and easy to treat the side effects The urine toxicology results were positive for Marijuana and caused by Haloperidol. It is seen periodically that the Emer- gency room physicians use Haloperidol as the drug of choiceto calm people down who are either aggressive or psychotic.
The patient was seen to be confused, incoherent, disoriented, The only problem is, when it is used in large doses the pa- dishelved with disorganized speech and violent behavior to- tient frequently ends up with severe side effects such as wards others. He would say things out of context and sen- acute Dystonia as seen in this patient. Physicians need to be tences which made no sense during the interview. He was very careful in using chemical restraints with patients and laughing inappropriately and also had crying spells simulta- keep in mind the potential side effects the patient might have neously. Patient was noticed to have been leaning his head towards his right side and was unable to move the neck. Atthe same time, patient had slurred speech with his tongue REFERENCES
protruding to the outside of his mouth. On examination he 1. Casey DE. Neuroleptic-induced acute dystonia. In: was not able to either move his neck or put his tongue back in Widiger TA, Frances AJ, Pincus HA, First MB, Ross R, Davis the mouth. Patient was in severe distress due to his awkward W, editors. DSM-IV source book. Vol. 1. Washington, DC: posture. This picture is typical of Dystonia, one of the ex- American Psychiatric Association; 1994. pp. 545–559. trapyramidal side effects of Haloperidol seen in males andyounger age groups. The patient was completely relieved of 2. Van Harten PN, Matroos GE, Hoek HW, Kahn RS. The the distress with intramuscular injections of Diphenhydramine prevalence of tardive dystonia, tardive dyskinesia, parkin- sonism and akathisia: the Curaçao extrapyramidal syn-dromes study: I. Schizophr Res. 1996;19:195–203. DISCUSSION
Dystonia is defined as a neurological movement disorder in
3. Van Harten PN, Hoek HW, Matroos GE, Koeter M, Kahn which sustained muscle contractions cause twisting and re- RS. Intermittent neuroleptic treatment and risk for tardive petitive movements or abnormal postures. The movements dyskinesia: Curaçao extrapyramidal syndromes study: III. which are involuntary and sometimes painful may affect a Am J Psychiatry. 1998;155:565–567. single muscle, a group of muscles such as those in the arms,legs, neck or the entire body. Acute Dystonia is a condition 4. Aguilar EJ, Keshavan MS, Martinez-Quiles MD, which can be induced in a person who gets medications like Hernandez J, Gomez-Beneyto M, Schooler NR. Predictors of Haloperidol. Acquired Torticollis is a form of dystonia which acute dystonia in first-episode psychotic patients. Am J Psy- affects the neck muscles and the face is turned to the same Continued on page 6
Volume 32, Number 4
El Paso Physician 5
Haloperidol Induced Dystonia
(Continued)
Syed O. Quadri, M.D., University of Arizona, Department of
5. Keepers GA, Casey DE. Prediction of neuroleptic-induced Psychiatry.
dystonia. J Clin Psychopharmcol. 1987;7:342–345. Cecilia DeVargas, M.D, Assistant Professor
6. Mazurek MF, Rosebush PI. Circadian pattern of acute, neu- Director of Child/Adolescent Unit at El Paso Psychiatric
roleptic-induced dystonic reactions. Am J Psychiatry.
1996;153
7. Nasrallah HA, Churchill CM, Hamdan-Allan GA. Higherfrequency of neuroleptic-induced dystonia in mania than in Adharsh P. Sahadevan, M.D., Resident Instructor, Texas Tech
schizophrenia. Am J Psychiatry. 1988;145:1455–1456. University H.S.C., Department of Neuropsychiatry, El Paso,
Texas.

8. Khanna R, Das A, Damodaran SS. Prospective study ofneuroleptic-induced dystonia in mania and schizophrenia. Am Lina Maria Reyes, M.D., University of Miami, Department of
Psychiatry and Behavioral Sciences.
9. Arana GW, Goff DC, Baldessarini RJ, Keepers GA. Efficacyof anticholinergic prophylaxis for neuroleptic-induced acutedystonia. Am J Psychiatry. 1988;145:993–996. 10. Rupniak NMJ, Jenner P, Marsden CD. Acute dystoniainduced by neuroleptic drugs. Psychopharmacology.
1986;88:403–419.
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Volume 32, Number 4

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