Synopsis
Recognise acute dystonia, akathisia, parkinsonism and tardive dyskinesia from their phenomenology and exposure timeline, separate them from psychiatric symptoms, and stop iatrogenic escalation while treating emergencies and preserving mental-health stability.
- Acute dystonia usually appears within hours to several days of a dopamine-blocking medicine or dose increase and causes painful sustained neck, jaw, eye, tongue or trunk postures.
- Akathisia is a distressing inner inability to keep still with pacing, rocking or repeated leg movement; it is commonly mistaken for agitation or worsening psychosis.
- Drug-induced parkinsonism develops over days to months with bradykinesia, rigidity and often bilateral symptoms, although asymmetry does not completely exclude a medication contribution.
Key red flags
Torticollis, jaw spasm, tongue protrusion, opisthotonus or sustained upward eye deviation soon after dopamine blockade is a painful acute dystonic reaction until an alternative is shown.
Investigation priorities
Link syndrome onset to antipsychotic, antiemetic, antidepressant, dopaminergic and withdrawal events.
Management branches
A painful patterned posture or oculogyric crisis begins soon after a dopamine blocker.
- 1. Assess airway, breathing, swallowing and laryngeal involvement, stop further culprit doses and call emergency support when speech, stridor or ventilation is affected.
- 2. Give protocol-dose parenteral procyclidine or the locally recommended anticholinergic and observe for response and recurrence.
Key medicines
Parenteral procyclidine for acute dystoniaA common adult emergency regimen is 5–10 mg intramuscularly or intravenously, with one repeat after about 20 minutes if needed within the current local maximum and observation protocol.
Propranolol for selected akathisiaAfter cardiovascular assessment, a specialist may start 10 mg two or three times daily and titrate cautiously to subjective and objective response under local guidance.