"Suffocating antipsychotics": Tardive laryngeal dystonia reported with risperidone
Tardive dystonia (TDt) is a rare but life-threatening complication, estimated to occur in 1%-4.0% of patients on antipsychotic medications. Although commonly associated with first generation anti-psychotics, in the recent edition of Indian Journal of Psychiatry by Jiwanmall et al. describe a case of tardive respiratory dystonia in a young male with schizophrenia while on risperidone.
Laryngeal dystonia (LD) is a functionally specific disorder of the afferent-efferent motor coordination system producing action-induced muscle contraction. Respiratory dystonia is a rare form of LD, which can result in respiratory distress. It characteristically disappears with sleep and does not alter the patient's voice during speech.
A 20-year-old single male presented with 4 years of schizophrenia characterized by social and occupational dysfunction, persecutory and referential delusions, and auditory hallucinations. Positive symptoms were remitted with risperidone (6 mg/day), while some negative and cognitive symptoms remained. Trihexyphenidyl (2 mg/day) was commenced when extra-pyramidal symptoms developed.
Nine months later, the patient reported with blepharospasm and episodic feelings of suffocation. These lasted several minutes during which he felt choked and unable to breathe, they remitted spontaneously, were absent during sleep, and did not affect speech.
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