This report describes a patient with schizophrenia who developed episodes of ocular dystonia as a delayed side effect of neuroleptic medication. Each episode was preceded and accompanied by marked agitation, stereotypic behaviour and exacerbation of hallucinations. Both the psychotic and dystonic symptoms responded to anticholinergic medication. The theoretical and practical implications of this observation are discussed.
References
1.
OeckinghausW. Encephalitis epidemica und Wilsonsches Krankheitsbild. Deutsche Zeitschrift fur Nervenheilkunde1921; 72: 294–309.
2.
SternF. Ueber psychische Zwangsvorgaenge und ihre Entstehung bei encephalitischen Blickkraempfen, mit Bermerkungen ueber die Genese der encephalitischen Blickkraempfe. Archives of Psychiatry1927; 81: 522–560.
3.
JelliffeSE. Psychological components in postencephalitic oculogyric crises: contributions to a genetic interpretation of compulsive phenomena. Archives of Neurology and Psychiatry1929; 21: 491–532.
4.
McCowanPKCookLC. Oculogyric crises in chronic epidemic encephalitis. Brain1928; 51: 285–309.
5.
OnuaguluchiG. Crises in post-encephalitic parkinsonism. Brain1961; 84: 395–414.
6.
DorevitchA. Neuroleptics as causes of oculogyric crises. Archives of Neurology1984; 41: 1516.
SwettC. Drug-induced dystonia. American Journal of Psychiatry1975; 132: 532–534.
9.
DorevitchA. Neuroleptics as causes of oculogyric crises. Archives of Neurology1984; 41: 15–16.
10.
ChiuLPW. Transient recurrence of auditory hallucinations during acute dystonia. British Journal of Psychiatry1989; 115: 110–113.
11.
LeighRJFoleyJMRemierBFCivilRH. Oculogyric crisis: A syndrome of thought disorder and ocular deviation. Annals of Neurology1987; 22: 13–17.
12.
LeighRJZeeDS. The neurology of eye movements. Philadelphia: FA Davis, 1991.
13.
RobinsonDA. Integrating neurons. Annual Review of Neuroscience1989; 12: 33–45.
14.
BenderMBShanzerA. Oculomotor pathways defined by electrical stimulation and lesions in the brain stem of monkey. In: BenderMB ed. The oculomotor system. New York: Harper & Row, 1964:81–96.
15.
KompfDPasikTPasikPBenderMB. Downward gaze in monkeys: stimulation and lesion studies. Brain1979; 102: 527–558.
SibonyPAEvingerCManningKA. Tobacco-induced primary position upbeat nystagmus. Annals of Neurology1987; 21: 53–58.
18.
MarsdenCDJennerP. The pathophysiological basis of extrapyramidal movement disorders. Psychological Medicine1980; 10: 55–71.
19.
SethyVHvan WoertMH. Modification of striatal acetylcholine concentration by dopamine receptor agonists and antagonists. Research Commuications in Chemical Pathology and Pharmacology1974; 8: 13–28.
20.
CaseyDEGerlachJChristenssonA. Dopamine, acetylcholine and GABA effects in acute dystonia in primates. Psychopharmacology1980; 70: 83–87.
21.
NasrallahHAPappasNHCroweRR. Oculogyric dystonia in tardive dyskinesia. American Journal of Psychiatry1980; 137: 850–851.
22.
ParkesJDBedardPMarsdenCD. Chorea and dystonia in parkinsonism. Lancet1976; 1: 155.
23.
CoolsARHendriksGKortenJ. The acetylocholine-dopamine blance in the basal ganglia of rhesis monkeys and its role in dynamic, dyskinetic and epileptoid motor activities. Journal of Neural Transmission1974; 36: 91–105.
24.
MeldrumBSAnlezarkGMMarsdenCD. Acute dystonia as an idiosyncratic response to neuroleptics in baboons. Brain1977; 100: 313–326.
25.
KolbeHClowAJennerPMarsdenCD. Neuroleptic induced acute dystonia reactions may be due to enhanced dopamine release onto supersensitive post-synaptic receptors. Neurology1981; 31: 434–439.
26.
ChristensenAVFjallandBNielsenMoller I. On the supersensitivity of dopamine receptors induced by neuroleptics. Psychopharmacology1976; 48: 1–6.
27.
FrankelMCummingsJL. Neuro-ophthalmic abnormalities in Tourette's syndrome: Functional and anatomic implications. Neurology1984; 34: 359–361.
28.
SramekJJSimpsonGMMorrisonRL. Anticholinergic agents for prophylaxis of neuroleptic-induced dystonic reactions; A prospective study. Journal of Clinical Psychiatry1986; 47: 305–309.
29.
CarlssonA. The current status of the dopamine hypothesis of schizophrenia. Neuropsychopharmacology1988; 1: 179–186.
30.
TandonRGredenJF. Cholinergic hyperactivity and negative symptoms. A model of cholinergic/dopaminergic interactions in schizophrenia. Archives of General Psychiatry1989; 46: 745–753.
31.
AlexanderGEde LongMRStrickPL. Parallel organization of functionally segregated circuits linking basal ganglia and cortex. Annual Review of Neuroscience1986; 9: 357–381.
32.
McDanielKDCummingsJLShainS. The “yips”: A focal dystonia of golfers. Neurology1989; 39: 192–195.
33.
ParkerGHadzi-PavlovicDBoyceP. Classifying depression by mental state signs. British Journal of Psychiatry1990; 157: 55–65.
34.
ManschreckTCMaherBARucklosMEVereenDR. Distributed voluntary motor activity in schizophrenic disorder. Psychological Medicine1982; 12: 73–84.
35.
StevensJR. Disturbances of ocular movements and blinking in schizophrenia. Journal of Neurology, Neurosurgery and Psychiatry1978; 41: 1024–1030.
36.
HolzmanPSProctorLRHughesDW. Eye tracking patterns in schizophrenia. Science1973; 181: 179–181.
