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
