Acute Dystonia PMHNP Exam

Описание: *Acute Dystonia in the PMHNP Exam*

*Acute dystonia* is a *severe, involuntary muscle contraction* that can occur *hours to days* after starting or increasing **dopamine-blocking medications**, such as **antipsychotics**. It is frequently tested on the **PMHNP-BC exam**, especially in the context of **extrapyramidal symptoms (EPS), first-generation antipsychotics (FGAs), and emergency management**.

*1. Causes of Acute Dystonia*
**Most commonly caused by first-generation (typical) antipsychotics (FGAs)**:
*High-potency FGAs:* *Haloperidol, Fluphenazine, Trifluoperazine*
*Moderate-risk FGAs:* *Chlorpromazine, Perphenazine*
*Second-generation (atypical) antipsychotics (SGAs)* can also cause it, but at a lower risk.
**Other dopamine-blocking agents**:
*Metoclopramide (Reglan)*
*Prochlorperazine (Compazine)*

*2. Clinical Presentation*
*Symptoms occur within hours to days of starting a dopamine-blocking drug.*
*Involuntary, painful muscle contractions* (usually head, neck, or upper body).

| *Type of Dystonia* | *Description* |
|--------------------|----------------|
| *Oculogyric crisis* | Sustained upward deviation of the eyes |
| *Torticollis* | Neck muscle contractions (twisting) |
| *Opisthotonos* | Severe back arching |
| *Laryngospasm* | Airway constriction → Can be life-threatening |
| *Buccolingual crisis* | Jaw clenching, tongue protrusion |

*3. Risk Factors*
*Young males* (less 30 years old)
*High-potency FGAs (Haloperidol, Fluphenazine)*
*Rapid dose increases*
*High doses of dopamine-blocking agents*

*4. Treatment of Acute Dystonia*
*First-line treatment:* *Anticholinergics or Antihistamines*
*Benztropine (Cogentin) 1–2 mg IM/IV*
*Diphenhydramine (Benadryl) 25–50 mg IM/IV*
*Second-line treatment:* *Benzodiazepines* (Lorazepam 1–2 mg IM/IV)
*Discontinue or reduce the offending medication* if possible.
*Prophylaxis:* If a patient had dystonia before, *co-administer Benztropine or Diphenhydramine* when restarting an antipsychotic.


*5. Acute Dystonia vs. Other Extrapyramidal Symptoms (EPS)*

EPS Type Onset Symptoms Treatment
Acute Dystonia Hours to days Painful muscle contractions Benztropine, Diphenhydramine
Akathisia Days to weeks Restlessness, pacing, agitation Beta-blockers (Propranolol), Benzodiazepines
Parkinsonism Weeks to months Tremor, rigidity, bradykinesia Benztropine, Amantadine
Tardive Dyskinesia Months to years Lip-smacking, grimacing, chorea Valbenazine, Deutetrabenazine


*6. PMHNP Exam Key Takeaways*
*Acute dystonia = Sudden, painful muscle contractions after antipsychotic use.*
*Common with FGAs (especially Haloperidol, Fluphenazine).*
*Best treatment = Benztropine (Cogentin) or Diphenhydramine (Benadryl) IM/IV.*
*If a patient had dystonia before, prophylaxis with Benztropine or Diphenhydramine is recommended.*
*Differentiate from akathisia (restlessness) and tardive dyskinesia (involuntary movements).*

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