Akademik Veri Yönetim Sistemi
Diğer, ss.202, 2019
ABSTRACT
Oculogyric crisis is an acute dystonic reaction of the ocular muscles associated with neuroleptic
medication, particularly typical antipsychotics. Dystonic reactions have been reported in 10–
60% of patients treated with neuroleptics, and are believed to occur more commonly in
patients just starting or increasing the dose of the neuroleptic. One report suggested that
90% of dystonic reactions occur within 4 days of starting a neuroleptic and can last from
seconds to hours. Risk factors for acute dystonic reactions include young age, male gender,
use of high-potency antipsychotics, high dose, and parenteral administration.
Case presentation: A 56-year-old female patient, primary school graduate, not working,
divorced was presented. The patient was brought to our clinic with complaints of
psychomotor agitation, mystic preoccupation, crying, persecution and reference delusions.
Prior to hospitalization, the patient was discontinued the paliperidone and was started on
haloperidol 10 mg/day and increased to 20 mg/day. Haloperidol deconate 100 mg IM was
administered to the patient whose agitation was continued and the dose of oral haloperidol
was reduced to 15 and 10 mg/day. The patient was treated with haloperidol deconate
100 mg IM on the 15th day. After the injection, the patient’s relatives said that he saw a
different movement in the eyes of the patient, but no findings were found in our follow-up
in the clinic. After the patient was discharged with the current treatment, the oral dose of
haloperidol was reduced to 5 mg/day and the patient was started on biperidene 2 mg tablet.
Dystonic reactions may also occur more frequently in the afternoon and in the evening. A
study evaluating 200 patients receiving antipsychotics for the first time found that >80% of
dystonic reactions occurred between 12.00 and 23.00 h. The mechanism by which
antipsychotics induce acute dystonic reactions is believed to be due to dopamine blockade
in the basal ganglia. Any medication that antagonizes nigrostriatal dopamine function has
the potential to cause dystonic reactions. In addition, presynaptic dopamine depletors (e.g.
reserpine) can cause acute dystonic reactions. Dopamine agonists or acetylcholine inhibitors
show an antidystonic effect. The use of anticholinergic agents to safely reverse dystonic
reactions indirectly supports this hypothesis. As shown in our case, the use of antipsychotics
is an effective factor for oculogyric crisis, even if it does not carry risk factors.