OVERVIEW
OVERVIEW
Late-onset dyskinesia is a stereotypically repetitive, persistent, and abnormal involuntary movement induced by antipsychotic medications, primarily seen in patients taking antipsychotic medications for a long period of time (1 year or more), most commonly as a result of phenothiazines and butyrophenazines.
Whether medical insurance
Yes
Department
Neurology, Psychiatry
Synonyms
Late Onset Hyperactivity Disorder, Late Onset Hyperactivity Disorder, Late Onset Dyskinesia, Persistent Dyskinesia
Clinical Symptoms
Clinically characterized by stereotyped repetitive, persistent, and abnormal involuntary movements.
Harms
Due to the motor disorders of lips, cheeks and tongue, tongue bite, dysarthria, dysphagia, dyspnea, fracture and other manifestations may occur.
Examination
Physical examination, blood routine, urine routine, etc.
Diagnosis
Diagnosis can be made on the basis of the history of taking antipsychotic drugs and abnormal involuntary movements.
Treatment principle
Remove the causative factors, actively prevent and control delayed dyskinesia.
Curability
The dyskinesia may gradually resolve or subside after stopping the medication.
Dietary advice
Diet should be light, easy to digest, avoid smoking and alcohol.
Questions you may be concerned about
What is delayed onset dyskinesia?
Delayed-onset dyskinesia is a specific and long-lasting extrapyramidal reaction, which is mainly characterized by involuntary movements of the mouth, lips and tongue, as well as choreographic movements of the limbs and trunk and dystonia.
Delayed-onset dyskinesia is common in psychiatric patients treated with long-term antipsychotic medications and is most likely to occur after dose reduction or discontinuation. It occurs more often in the elderly, especially in women, and is more common in the elderly with cerebral sexual lesions. Most patients have taken antipsychotics for more than 1 year.
The main clinical manifestation is involuntary, repetitive stereotyped movements. The lower facial muscles are most often involved, manifesting as uncontrollable movements of the mouth, lips and tongue, such as sucking, chewing, licking the tongue, pouting or licking the teeth inside the mouth and involuntarily sticking out of the mouth, and in severe cases, the biting is not clear and swallowing is impaired. The above symptoms are mainly oral and facial symptoms in adults and physical symptoms in children. Symptoms may worsen during emotional stress and excitement, but disappear during sleep.
Delayed dyskinesia is mainly preventive in clinical practice, with strict control of the indications for the application of antipsychotic drugs and emphasis on the rational use of medication.
Etiology
Epidemiology
The disease is most common in elderly women. The incidence of oral general antipsychotics is 20% to 40%, and the incidence of using long-acting antipsychotics is about 50%.
Etiology
Delayed dyskinesia is most commonly caused by long-term (more than 1 year) high-dose administration of antipsychotics that block dopaminergic receptors, or bind to them, especially phenothiazines such as chlorpromazine phenazine, and butyrylbenzenes such as haloperidol. Certain dopamine drugs such as levodopa, methyldopa, and parkinol tranquilizers can also cause similar delayed dyskinesias, occasionally when they are tapered or discontinued in patients who have been taking long-term antidepressants, antiparkinson’s disease medications, antiepileptics, and antihistamines.
Symptoms and Diagnosis
Typical symptoms
1. Mostly occur in the elderly, especially women, especially in the elderly with organic brain lesions. Most of them have been taking antipsychotics for more than 1 year, and the shortest time of occurrence is 3 months, and the longest time is 13 years. 2. Clinical manifestations mainly include involuntary, rhythmic, and repetitive stereotyped movements. Involvement of lower facial muscles is the most common, manifested as repetitive and uncontrollable movements of lips and tongue, such as sucking, licking tongue, chewing, pouting, crooked jaw or tongue licking teeth in the mouth, and sometimes the tongue involuntarily and suddenly extends out of the mouth, which is known as flycatcher’s tongue sign, and in severe cases, dysarthria and swallowing disorders are observed. Trunk muscle involvement is characterized by repeated flexion and extension of the trunk, which is called the body shaking sign. The distal limbs show continuous flexion and extension movements, which is called the piano finger (toe) sign. The proximal limbs are rarely involved. The above symptoms are more common in adults with oral and facial symptoms and in children with physical symptoms. Symptoms worsen during emotional stress and excitement, but disappear during sleep.
Diagnostic basis
1. the patient has a history of taking antipsychotic medication, mostly for more than 1 year. 2. the symptoms start while the patient is still taking the medication or within 3 months after stopping the medication. 3. the dyskinesia is characterized by rhythmic, abnormal, stereotyped and repetitive involuntary rapid movements. 4. there are no other specific positive signs and examination findings.
Treatment
Treatment guidelines
1. promptly reduce or discontinue the antipsychotic medication being taken. 2. control delayed dyskinesia. 3. change antipsychotic therapy.
Medication
Medications such as rifampicin, iproniazid, olanzapine, sodium valproate, thiopental, sulpiride, buprenazine, punarol, alprazolam, etc. may be used to relieve symptoms.
Other treatments
Deep brain stimulation (DBS) may be used if medication is ineffective.
Prognosis
The disease usually resolves or subsides within a few months or 1 to 2 years after stopping the medication. Treatment of delayed-onset dyskinesia is generally quite difficult and less effective.
Nursing care
Daily care
1. Keep the environment quiet and clean, indoor air fresh, open the windows regularly for ventilation. 2. Pay attention to rest, live a regular life, ensure enough sleep, and exercise appropriately. 3. Regulate the psychological state, keep the mood happy, actively cooperate with the treatment, and avoid aggravation of the condition by bad emotions.
Diet regulation
Reasonable diet structure, choose light, easy to digest, low-fat, high protein, vitamin-rich diet; eat more fruits, vegetables and potassium-rich foods, less cholesterol-rich foods and animal offal, egg yolks and animal oils; eat regularly, quit smoking and limit alcohol, and prohibit overeating.