Movement Disorders (Acute dystonia, Akathisia, Parkinsonism, Tardive dyskinesia)

At-risk populations for Parkinsonism

1. Acquired immune deficiency syndrome 2. Advanced age 3. Dementia 4. Female sex

Parkinsonism 1. First-line: 2. Second-line: 3. Third-line:

1. Benztropine Amantadine 2. Levodopa 3. ECT

At-risk populations for Akathisia

1. Cognitive impairment 2. Female 3. High-potency antipsychotics 4. History of akathisia 5. Iron deficiency 6. Mood disorder 7. Negative symptoms 8. Older age 9. Rapid dose escalation

Refractory RLS 1. First-line: 2. Second-line:

1. Combination therapy 2. Opioid monotherapy

Acute dystonia treatment 1. First-line: 2. Second-line:

1. Diphenhydramine, Benztropine 2. Lorazepam, Diazepam

Drugs that induce Tardive dyskinesia

1. Dopamine antagonists 2. Anti-emetics

Drugs that induce Parkinsonism

1. Dopamine antagonists 2. Antidepressants 3. Antiepileptics

Drugs that induce Acute dystonia

1. Dopamine antagonists 2. SSRIs

Drugs that induce Akathisia

1. Dopamine antagonists 2. SSRIs 3. Antiepileptics

At-risk populations for acute dystonia

1. High-potency antipsychotics 2. ECT 3. Male 4. Previous episode of acute dystonia 5. Recent cocaine use 6. young age

Intermittent RLS treatment 1. First-line: 2. Second-line:

1. Non pharm 2. On-demand treatment

Chronic persistent RLS 1. First-line: 2. Second-line: 3. Third-line:

1. Nonpharm 2. Alpha2delta ligand 3. Non-ergot DA agonist

Non-modifiable risks for Tardive dyskinesia

1. Older age 2. Female 3. Genetics

Akathisia treatment 1. First-line: 2. Second-line:

1. Propranolol 2. Mirtazapine 3. Amantadine, Trazodone

What is Parkinsonism?

2 of the following: Tremor, Rigidity, Bradykinesia

Barnes Akathisia Rating Scale (BARS) -score needed to begin pharmacologic therapy:

3

Simpson Angus Scale (SAS) -score needed to begin pharmacologic therapy:

6

Scale used to assess tardive dyskinesia

Abnormal Involuntary Movement Scale (AIMS)

What scale is used to assess Akathisia?

Barnes Akathisia Rating Scale (BARS)

What is restless leg syndrome (RLS)?

Condition where legs feel extremely uncomfortable unless they are being moved. Feels like creeping, crawling, jittery, tingling, burning, aching.

What is Akathisia?

Difficulty staying still

What is Tardive dyskinesia?

Hyperkinetic involuntary movement disorder

What is Acute dystonia?

Involuntary contractions of muscles of the extremities, face, neck, abdomen, pelvis, or larynx in either sustained or intermittent patterns that lead to abnormal movements or postures

Restless Leg Syndrome (RLS) Nonpharm treatment:

Iron, abstain from caffeine and alcohol

What scale is used to assess Parkinsonism?

Simpson Angus Scale (SAS)

Tardive dyskinesia Pharmacologic treatment:

VMAT2 inhibitors