Geodon and Oculogyric dystonia

[Anasazi23]

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I had a case the other night on call. I was suspicious, but it seemed definately genuine.

Anyone seen this?

 

[fiatslug]

haven't seen it, with Geodon or anything else. Any other NMS-type sx present? Never seen NMS either! Was just reviewing the McLean criteria for our upcoming PRITE review sessions:

Neuroleptic Malignant Syndrome: Usually develops w/in 1-3 days of starting an antipsychotic (at most one month). McLean criteria:

1. hyperthermia in absence of other known etiology.

2. Severe EPS—2 or more: lead pipe rigidity, oculogyric crisis, pronounced cogwheeling, retrocollis, sialorrhea, opisthotonos, trismus, dysphagia, chorieoform movements, festinating gait, flexor-extensor posturing.

3. Autonomic Dysfunction—2 or more: HTN, tachycardia, prominent diaphoresis, incontinence. Also: delirium, >15K WBCs, CK >1000. Tx: bromocriptine, dantroline, supportive.

 

[Anasazi23]

haven't seen it, with Geodon or anything else. Any other NMS-type sx present? Never seen NMS either! Was just reviewing the McLean criteria for our upcoming PRITE review sessions:

Neuroleptic Malignant Syndrome: Usually develops w/in 1-3 days of starting an antipsychotic (at most one month). McLean criteria:

1. hyperthermia in absence of other known etiology.

2. Severe EPS—2 or more: lead pipe rigidity, oculogyric crisis, pronounced cogwheeling, retrocollis, sialorrhea, opisthotonos, trismus, dysphagia, chorieoform movements, festinating gait, flexor-extensor posturing.

3. Autonomic Dysfunction—2 or more: HTN, tachycardia, prominent diaphoresis, incontinence. Also: delirium, >15K WBCs, CK >1000. Tx: bromocriptine, dantroline, supportive.

NMS I've seen and treated a few times. It's scary and you'll know it when you see it.

Oculogyric crisis or dystonia is more subtle. Of course, it requires immediate diagnosis and intervention. The guy looked sort of like this:
🙄

But with more of a disturbed/psychotic/anxious/component.

Rest easy, we took care of it and he improved quickly with intervention.

 

[50960]

Never seen with Geodon, but had 2 cases when I worked inpatient of oc crisis with risperdal, and one reported that I did not see with zyprexa. How did you tx?

 

[Anasazi23]

Never seen with Geodon, but had 2 cases when I worked inpatient of oc crisis with risperdal, and one reported that I did not see with zyprexa. How did you tx?

The patient in question was floridly psychotic in addition to his oculogyric problem. I was reluctant to stop an antipsychotic completely. He also was recently withdrawal akithetic from another neuroleptic.

He responded to benztropine 2IM and seroquel (which we know can be protective against dystonia and reduce tardive due to its pharmacokinetic properties).