Objective: To represent a case of acute dystonic dyskinesias after breхpiprazole use by the patient with frontotemporal dementia (behavioral variant)

Background: Drug-induced movement disorders (DIMDs) are a significant concern in psychiatric practice, particularly among elderly patients with dementia [1,2]. While first- and second-generation antipsychotics are most commonly associated with motor side effects, third-generation antipsychotics (TGA) are increasingly used in this population due to their improved tolerability profile. However, emerging evidence suggests that even TGA can induce DIMDs, particularly in vulnerable populations like elderly patients with dementia [3]. This case study highlights the occurrence of acute dystonia in a 70-year-old female patient with dementia following the administration of brexpiprazole.

Method: A 70-year-old female patient with a history of anxiety following a COVID-19 infection was admitted to a psychiatric hospital with complaints of auditory hallucinations and delusions of technological control. The patient reported hearing voices that threatened her and her sister’s lives, accusing her of criminal activities. Magnetic resonance imaging (MRI) of the brain revealed moderate focal dystrophic changes and cerebral atrophy predominantly in frontal and temporal lobes. Brexpiprazole 1 mg daily was initiated to manage the hallucinatory-delusional symptoms.

Results: Within 24 h of initiating brexpiprazole, the patient developed acute dystonia with anterocollis. The antipsychotic was discontinued, and treatment was switched to amantadine sulfate 500 mg IV for 3 days, followed by oral tabs 100-100-0 mg daily. The patient’s condition improved significantly within a week, with resolution of the dystonic symptoms and partial improvement in psychiatric symptoms.

Conclusion: This case underscores the potential for TGA to induce acute dystonia in elderly patients with dementia, despite their reputation for fewer motor side effects. The patient’s advanced age, underlying cerebral atrophy, and dementia likely contributed to her heightened susceptibility to DIMDs. Clinicians should remain vigilant for motor side effects, even with newer antipsychotics, and be prepared to intervene promptly. Further research is needed to better understand the risk factors and mechanisms underlying DIMDs in this population and to develop safer therapeutic strategies.

References: 1. Pandey, S., Pitakpatapee, Y., Saengphatrachai, W., Chouksey, A., Tripathi, M., & Srivanitchapoom, P. (2023). Drug-Induced Movement Disorders. Seminars in Neurology, 43, 035 – 047. https://doi.org/10.1055/s-0043-1763510.
2. Ruangritchankul, S., Peel, N., Hanjani, L., & Gray, L. (2020). Drug related problems in older adults living with dementia. PLoS ONE, 15. https://doi.org/10.1371/journal.pone.0236830.
3. Caligiuri, M., Jeste, D., & Lacro, J. (2000). Antipsychotic-Induced Movement Disorders in the Elderly. Drugs & Aging, 17, 363-384. https://doi.org/10.2165/00002512-200017050-00004.

« Back to 2025 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/drug-induced-movement-disorders-in-elderly-patients-with-dementia-a-case-study-of-acute-dystonia-following-third-generation-antipsychotic-use/