Tardive dyskinesia treatment?

[DwayneEMTP]

Guys....Just because it's a research questions doesn't mean that he's not interested in general discussion on the topic, right? I'm rarely satisfied simply by "answers" found through peer reviewed sources as they don't answer all of the questions that I might have on the subject.

Once again we're being a bit hard on a new member for bringing a really good question...I had to Google TD as I'd not even heard those words in years....

Why is it so important to demand to know why he's asking the question? Participate, or don't...easy, right?

[itku2er]

I would have to ask how long had they been on the medication. I would also ask if he had shown any signs of any "parkinson like symptoms" before this episode. Seizures are usually a secondary problem related to Haldol use , if they have a seizure they more than likely have some kind of underlying organic brain dysfunction of some kind. I would also like to know if they were on any other kind of psychotropic drugs. Just a few things running through my pea brain.

[paramedicmike]

C'mon, Dwayne. You've had similar responses to people showing up here expecting that we do their homework for them. I'll admit I thought that was the case with the OP simply given his initial presentation. He and I had a productive chat and I'm now confident that this isn't the case. But you have to admit the initial presentation was spot on for all those others who were expecting us to do the work for them.

It is an excellent question and has started some good discussion. I hope it continues.

[Doczilla]

A key thing here is to know the difference between a dystonic reaction and tardive dyskinesia. Both can occur with the "typical" antipsychotic medications such as Haldol, Thorazine, and others. Medications such as Reglan and Compazine can also do it.

A dystonic reaction is similar to what you describe. It can happen with the first dose or any subsequent dose of a medication, particularly if combined with other similar medications or after a dose adjustment. The onset is fairly sudden, and they may not have had anything similar before. I have seen this effect also from "energy drinks". I also saw this after administration of a dose of Zofran in the ER, but failed to find any reference in the literature to such reactions being common. Treatment is supportive, and benztropine (Cogentin) or benadryl can be given for the effects and is usually pretty effective. A dystonic reaction is reversible with no lasting effect.

Tardive dyskinesia is an insidious movement disorder that can be caused by long term use of antipsychotic medications. It more closely resembles Parkinson's disease, with movement difficulties, ataxia, and cogwheel rigidity. The onset is over weeks to months and is not reversible. It is typically permanent.

'zilla

[spenac]

Guys....Just because it's a research questions doesn't mean that he's not interested in general discussion on the topic, right? I'm rarely satisfied simply by "answers" found through peer reviewed sources as they don't answer all of the questions that I might have on the subject.

Once again we're being a bit hard on a new member for bringing a really good question...I had to Google TD as I'd not even heard those words in years....

Why is it so important to demand to know why he's asking the question? Participate, or don't...easy, right?

C'mon, Dwayne. You've had similar responses to people showing up here expecting that we do their homework for them. I'll admit I thought that was the case with the OP simply given his initial presentation. He and I had a productive chat and I'm now confident that this isn't the case. But you have to admit the initial presentation was spot on for all those others who were expecting us to do the work for them.

It is an excellent question and has started some good discussion. I hope it continues.

Wow the new polite Dwayne is scary.

[mobey]

Since you are just learning, it is inappropriate to make statements about ruling out seizure that you made earlier.

This looks like a clear cut Dystonic reaction, and therefore I would "trial" Benadryl I.V.

If that does not do the trick, I would move to Benzodiazepines under the differential diagnosis of partial complex seizure.

Think horses my friend.

Welcome to the forum BTW:

[Eydawn]

Here's a question: Would it be harmful, in any way, to move for the diphenhydramine prior to the benzos if this were a partial complex seizure? If you're truly approaching this from the perspective of a potential prehospital call, will you really be immediately jumping to dystonic reaction as your exclusive (or primary) differential diagnosis, and if so, would it be wiser to prioritize benzodiazepenes with regard to the neurologic symptoms you're seeing?

(I don't know the answer to this; I'm curious as to what the OP's take and the smarter folks' brains want to do with regard to this question.)

Wendy

CO EMT-B

RN-ADN Student

[BAYAMedic]

Ey,

With known HX of Haldol, that presentation lead to extra pyramidal unless I see something else jumping out at me. Giving the Diphenhydramine first you have a (semi) conclusive R/O of the Dystonia. With a complex focal Seizure, the Benzos will break the Seizure, but what caused it in the first place? Any time I can treat something that treats a causative issue or gives a diagnosis versus treating a symptom, I would prefer to go down that track.

BAYAMedic

Secondary thought and answer.

Harm in going with the dyphenhydramine before Benzos? Its a stretch but I would say the potentiation between the two would cause increased somnolence and possible respiratory depression.

BAYAMedic

Edited September 3, 2012 by BAYAMedic

[Eydawn]

I like it, BAYA. And I guess we could treat for the sedation by managing airway, so not as huge a deal here...

Now, to dive off into tangent land... as I recall, Reglan is one of the antiemetics that is approved for use in pregnant women. Would your treatment for dystonia change if your patient was pregnant? What extra considerations would you take into account, if any?

;-)

Wendy

CO EMT-B

RN-ADN Student

[mikeymedic1984]

I always administered Benadryl for phenothiazine reactions. I may have missed it in here, but Phenergan is also a phenothiazine. I probably have not seen one in the last 8 years, because other meds have taken the place of commonly prescribed phenothiazines.