Drug-induced Movement Disorders

Summary

The use of atypical antipsychotic agents for populations that had never previously been exposed to the agents, i.e., children, adolescents, and the elderly, and a wider use in the adult population, combined with a lack of long-term trials that would accurately indicate the rate of DIMD in these populations portends an increase in the number of cases of DIMD. Other issues that may increase the number of cases of DIMD include lack of understanding or complacency among physicians when prescribing DRBD. Recognition of DIMD is often lacking, even among psychiatrists and neurologists, but is essential in the treatment of these disorders. Prevention and early recognition of the symptoms comprise the best method of managing DIMD.

Table 2—The Prevention of DIMD

Inform	Weigh the risks of DIMD and benefits of treatment before instituting therapy with a DRBD. Inform patients, and, if appropriate, their family members, about these risks.
Restrict	Restrict the use of DRBD to only those patients for whom no alternative treatment is available.
Limit	Limit exposure by keeping the dose of DRBD to the lowest possible level.
Assess	Every three months, reassess the patient's need for continued treatment with a DRBD.
Switch	When possible, switch patients to a medication that has limited antagonism of dopamine receptors; for example, consider using an atypical antipsychotic rather than a typical antipsychotic drug or a 5HT3-receptor blocking antiemetic instead of metoclopramide or compazine.
Examine	Every three months, examine patients who are taking a DRBD for symptoms of DIMD.