56 Medication-Induced Movement Disorders and Other Adverse Effects of Medication
Alexandria Lewis
Content Outline, Competency, and KSAs
II. Content Outline: Assessment and Intervention Planning
IIB. Competency: Assessment Methods and Techniques
KSAs:
– The use of the Diagnostic and Statistical Manual of the American Psychiatric Association
Source of information about DSM diagnoses: American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Publishing.
overview
Medication-induced movement disorders are included in Section II due to their significant role in two key areas:
- Managing mental or medical conditions with medications.
- Distinguishing between psychiatric diagnoses (for example, differentiating anxiety disorders from medication-induced akathisia, or distinguishing between malignant catatonia and neuroleptic malignant syndrome, and between tardive dyskinesia and chorea).
Despite being categorized as “medication-induced,” these disorders can be challenging to attribute directly to medication use, as some may also emerge without pharmaceutical exposure.
Note: These conditions are included in the DSM for clinical relevance, especially in differential diagnosis. They are coded for practical reasons but are not psychiatric diagnoses.
Medication-induced movement disorders and other adverse effects
| Disorder | Key Features | Typical Onset | Common Causes | Risk Factors |
|---|---|---|---|---|
| Medication-Induced Parkinsonism | Tremor, rigidity, bradykinesia, gait disturbance | 2–12 weeks after medication start or dose increase | High-potency antipsychotics, calcium channel blockers, SSRIs, lithium | Older age, female gender, cognitive issues |
| Neuroleptic Malignant Syndrome | Hyperthermia, severe rigidity, altered consciousness, autonomic instability | Hours to 30 days | All dopamine antagonists, esp. high-potency antipsychotics | Dehydration, agitation, fast titration, prior NMS |
| Medication-Induced Acute Dystonia | Painful sustained muscle contractions (e.g., eyes, jaw, neck) | Within 1–5 days | Antipsychotics, antiemetics, SSRIs | Younger age, male, prior dystonia |
| Medication-Induced Acute Akathisia | Inner restlessness, pacing, inability to stay still, anxiety | Within 4 weeks of dose start or change | Antipsychotics, SSRIs, TCAs | Dose-dependent, high-potency meds |
| Tardive Dyskinesia | Involuntary, repetitive movements (face, limbs, trunk) | After 3+ months of use | Antipsychotics, metoclopramide | Age, EPS history, cumulative exposure |
| Tardive Dystonia / Akathisia | Persistent dystonia or akathisia after long-term medication use | Late onset, may persist after stopping | Antipsychotics and dopamine blockers | Long exposure duration |
| Medication-Induced Postural Tremor | Fine tremor during sustained posture, worsens with action | Variable | Lithium, caffeine, SSRIs, stimulants | Anxiety, stress, caffeine, alcohol use |
| Other Medication-Induced Movement Disorder | Atypical movement symptoms not otherwise categorized | Variable | Various agents (e.g., mimicking NMS, tardive) | Varies |
| Antidepressant Discontinuation Syndrome | Dizziness, “brain zaps,” insomnia, anxiety | 2–4 days after stopping the medication | Short half-life antidepressants (e.g., paroxetine) | Fast taper, irregular use |
| Other Adverse Effects of Medication | Non-motor side effects (e.g., hypotension, arrhythmias) that become clinical focus | Varies | Any drug | Dependent on specific adverse effect |
Medication Side Effects Can Mimic Psychiatric Symptoms
-
Akathisia can look like anxiety or agitation.
-
Parkinsonism may resemble negative symptoms of schizophrenia.
-
Tardive dyskinesia might be mistaken for tics or psychomotor agitatio
Things to Consider When Taking the Exam
- Symptoms like tremors, rigidity, or agitation can mimic anxiety, psychosis, or catatonia.
- Consider when symptoms could be iatrogenic (medication-induced) instead of psychiatric.
- Questions may test your ability to distinguish between medication side effects and mental disorders. While social workers are not prescribers, they play a crucial role in recognizing side effects, advocating for clients, and communicating with medical providers.
-
Symptoms like akathisia and dystonia emerge quickly (within days).
-
Parkinsonism and tardive disorders often appear weeks to months later.
