<prompt> A child with schizophrenia was on medications. Suddenly he developed neck stiffness 8t spasm. What is most probable cause?Conversion disorderAcute dystoniaAkathisiaTardive dyskinesia  <response>: ANSWER: BAcute dystoniaREF: Kaplan and sadocks synopsis in psychiatry 10th ed page 992This is a case of acute dystonia due to neuroleptic medicationsSee APPENDIX-38 below for NEUROLEPTICS SIDE EFFECTS APPENDIX - 38Neuroleptics; Side Effects Acute DystoniaAkathisiaParkinsonismTardive DyskinesiaNeurolepticMalignantSyndrome EarlyIntermediateIntermediateLate tardiveAnyONSETWithin 7 days of therapy or doseWithin 3 months of therapy or doseWithin 3 months of therapy or dose 3-6 months dose may unmask dyskinesiaAnytime during therapy dose or high potency drugsINCIDENCE15-20 with typical neuroleptics. 5 with atypical20305 per year of therapy i.e. 50 In 10 years0.520-30mortalityMECHANISMUnclear, dopamine hypo function at basal gangliaD2 receptor blockage in mesocortical pathwayD2 receptor blockage at striatumD2 receptor blockage at striatumIdiosyncratic, Relative depletion of dopamine in CNSRISKFACTORSMale, young, mental retardation, ho ECT, dose elevationElderly,female, mental retardation, Iron deficiency, Affective disorders, dose elevationElderly ,Females,dementia,underlyingparkinsonism,AIDS, doseelevationElderly, female, ho ECT, substance abuse, iron deficiency, Mental retardation. Mood disorder, Organic brain damage, Antkholine rgic Dose decreaseMale, young, dose elevationSYMPTOMSSlow, irregular, continuous contractions, oculogyric movements of tongue, torticollis, trismus, abnormal posture, blepherospasmUncontrolledrestlessness,pacing,compulsive foot taping, rocking movement, adversity to stand still, rapid alternation of standing St- sittingR rigidityA akinesia meT tremoratyp ical-coarse, not pill rolling, late RABBIT SYNDROME Lip perioral tremorsRapid, irregular, continuous or intermittent contractions, orofasciolingual or limbtrunkal, by stress activity,Life threateningF feverE EncephalopathyV - Vitals unstableE ElevatedCPK, WBCR RigidityTREATMENTAnticholine rgics: Benzatropine Antihistaminics: DiphenhydramineReduce doseStor changeantipsychotic.Propranolol doc, poortreatmentoutcomeAnticholinergics:BenzatropineAntihistaminics:Amantadine,DiphenhydramineReplace by atypical antipsychotic clozapine is best, lithium carbamazepine for psychosis, BZD: buspirone for dyskinesiaBromocriptine,lisuride,carbidopa-levodopa,dantrolenesodium, ECT 