td vs eps

[cherryalmond]

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So i am sure all of the smart people on here will jump in on this question as maybe the answer is obvious. Yes i am aware that eps is a broad term including dystonias,akathisia,dyskinesias. An elderly female patient who has been on risperdal for several months came in for follow up with lip movements,like chewing. She had no other abnormal movements. I immediately thought of eps but later wondered how i knew it was not tardive. She is on cogentin from a previous doc. This patient was diagnosed with delusional disorder several mnths ago and had no psyc history prior to that so she has not been on a million different antipsychotics. This was my first time seeing her but i was told by the secretary she has had those movements for at least the last 3 visits

 

[nitemagi]

Sounds like it could be rabbit syndrome.

 

[psychattending]

From the description of the movements it sounds like TD. 3 months, though, is on the rapid side for developing it.

Pharmacologically TD acts the opposite of EPS. Add more D2 blockade and TD gets better acutely (EPS worse). Take away D2 blockade and TD will worsen acutely but EPS will improve.

 

[heyjack70]

Chewing motion sounds like TD. With EPS I think more of a repetitive oscillating tremor 3-6 Hz. TD is irregular rhythm, eg lip smacking, tongue rolling, choreic movements.