Antipsychotic-induced acute laryngeal dystonia: A systematic review of case reports

Paul A. Maguire*, Matthew Brazel, Jeffrey C.L. Looi

*Corresponding author for this work

    Research output: Contribution to journalReview articlepeer-review

    Abstract

    Acute laryngeal dystonia (ALD) is a rare but potentially life-threatening complication of both first-generation (FGA) and second-generation (SGA) antipsychotic medication. Delays in diagnosis and treatment have been associated with mortality. We carried out a systematic review of antipsychotic-induced acute laryngeal dystonia using the databases Ovid MEDLINE, PubMed, CINAHL, and EMBASE. Search terms included: (antipsychotic* OR antipsychotic-induced OR neuroleptic* OR neuroleptic-induced) AND (laryngeal dystonia* OR laryngo-pharyngeal dystonia* OR laryngospasm OR laryngeal spasm OR dystonic reaction* OR extrapyramidal reaction*) where * specified plural forms of the relevant word. Forty articles (describing 45 cases) met eligibility criteria. ALD occurred with both first- and second- generation antipsychotics but was more commonly reported in FGAs. ALD occurred in association with low, moderate and high doses (within the usual dose ranges of both high and low potency agents). Young males appeared to be most at risk of antipsychotic-induced ALD, especially those treated with high potency agents. Anticholinergic medication (including antihistamines with anticholinergic properties) usually provided rapid and effective relief, especially if administered parentally. Vigilance is indicated for idiosyncratic ALD emergence when initiating, or increasing the dose of, an antipsychotic medication. Rapid treatment with an anticholinergic medication is recommended to prevent adverse outcomes.

    Original languageEnglish
    Pages (from-to)248-262
    Number of pages15
    JournalSchizophrenia Research
    Volume264
    DOIs
    Publication statusPublished - Feb 2024

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