Rabbit syndrome - a rare complication of long-term neuroleptic medication

Article Abstract:

Rabbit syndrome is a rare disturbance of orofacial movement (movement of the lips, mouth and jaw) associated with the long-term use of neuroleptics (anti-psychotic medications). Unlike tardive dyskinesia, another movement disorder associated with long-term neuroleptic use, there is no involvement of the tongue in rabbit syndrome. The case report of a 52-year-old male schizophrenic who had been taking neuroleptics for almost 20 years is presented. During a clinic visit, he demonstrated rapid, involuntary orofacial and jaw movements. No involuntary movements of the tongue or any other part of his body were noted. A diagnosis of rabbit syndrome was made. He was taken off neuroleptics, and was treated with oral trihexyphenidyl (an antiparkinsonian agent). After three days the facial movements began to improve, and by the fifth day all the symptoms had disappeared. However, he was non-compliant and stopped taking the trihexyphenidyl. Orofacial and jaw movements reappeared within five days. Since his symptoms stopped and started with the starting and stopping of the antiparkinsonian agent, it seems likely that rabbit syndrome responds to this class of drug. This finding appears to indicate that rabbit syndrome may be related to drug-induced parkinsonism (another movement disorder caused by neuroleptics, which is marked by slow movements, tremor and rigidity), and that response to antiparkinsonian agents may provide a diagnostic tool for differentiating rabbit syndrome from tardive dyskinesia. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Pisa syndrome in an adolescent on neuroleptic medication

Article Abstract:

Pisa syndrome is a side effect of antipsychotic (neuroleptic) medication, which involves flexion and rotation of the neck and trunk of the body to one side. No cases of Pisa syndrome among children and adolescents have been previously reported. A case report of a 15 year-old girl who developed this syndrome after four days of treatment with a neuroleptic (trifluoperazine) is presented. Her family members had no history of psychiatric disorders. The girl was delivered by Caesarean section and had required intensive care treatment for two weeks. The child seemed to progress well until age seven when she underwent several operations for an arm fracture. After this, she found it difficult to write, lost interest in school, and began to withdraw and isolate. By age 12, she became seriously paranoid; the patient insisted that her mother was an impostor and claimed that she was given contaminated food. Her behavior became increasingly aggressive, odd, and inappropriate. After being admitted to a psychiatric unit and diagnosed with schizophrenia, she was treated with trifluoperazine. Four days later, she became restless began leaning her neck and torso to the right side. The medication was withdrawn and within a week all Pisa symptoms subsided. The symptoms observed in this case were similar to those reported in adults with Pisa syndrome. It is suggested that this syndrome may occur frequently among children and adolescents receiving neuroleptic drugs, but that it may be misdiagnosed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Schizophrenia in children, Childhood schizophrenia

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Prophylactic use of anticholinergics in patients on long-term neuroleptic treatment: a consensus statement

Article Abstract:

Side effects of treatment with neuroleptics, which are a class of drug commonly used to treat schizophrenia, include Parkinsonian symptoms such as uncontrolled trembling of the extremities. These are called extrapyramidal side effects. Anticholinergics, on the other hand, are drugs that block these effects and they are often given as a preventive measure for people treated chronically with neuroleptics. Unfortunately, anticholinergics may cause their own side effects. Long-term use of anticholinergics can cause tardive dyskinesia, which is a chronic condition characterized by involuntary movement of the lips and jaw, the disruption of autonomic processes such as urine elimination, the disruption of cognitive processes, and increased body temperature. They are toxic in too high a dosage, they can be abused as euphoria-inducing drugs, and they can decrease the therapeutic efficacy of neuroleptics. Many patients treated with neuroleptics never develop Parkinsonian symptoms, and therefore prophylactic treatment with anticholinergics may be useless in some cases. Given the risks, it is the consensus of the World Health Organization that anticholinergics not be used prophylactically in patients on long-term neuroleptic treatment. Rather, they should only be used when there is evidence of Parkinsonism, and other measures to reduce the symptoms have failed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Mentally ill persons, Causes of, Social policy, Mentally ill, Drug therapy, Combination, Combination drug therapy, World Health Organization, Parasympatholytic agents, Parasympatholytics, Psychoses, Psychotic disorders, editorial, Extrapyramidal disorders

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