Acatisia inducida por antipsicóticos: recomendaciones para la práctica clínica / Antipsychotic-induced akathisia: recommendations for clinical practice

La acatisia es uno de los eventos adversos inducidos por antipsicóticos más prevalentes y puede generar severa angustia en quien lo experimente. Se caracteriza por inquietud psicomotora objetiva y subjetiva. Pertenece al gran paraguas de los "síntomas extrapiramidales", sin embargo, tiene sus particularidades clínicas lo que representa un desafío clínico, tanto en su diagnóstico como en su manejo específico. La presente revisión sintetiza la información disponible a la fecha y ofrece al clínico recomendaciones para prevenir, reconocer y manejar esta complicación frecuente de una de las familias de psicofármacos de mayor prescripción clínica en la actualidad.

Abstract. Akathisia is one of the most prevalent antipsychotic-induced adverse events and causes severe distress in those who experience it. It is characterized by objective and subjective psychomotor restlessness. Usually classified under the great umbrella of extrapyramidal symptoms; however, it has its own clinical peculiarities, which might represent a challenge for the clinician in diagnosis as well as specific management. This review synthesizes the information available to date on antipsychotic-induced akathisia and offers the clinician recommendations to prevent, recognize and treat this prevalent complication of one of the most widely prescribed psychotropic medications today.

The correlation among the Ramsay sedation scale, Richmond agitation sedation scale and Riker sedation agitation scale during midazolam-remifentanil sedation / Correlação entre a escala de sedação de Ramsay, escala de sedação-agitação de Richmond e escala de sedação-agitação de Riker durante sedação com midazolam-remifentanil

Abstract Background and objectives: Sedative and analgesic treatment administered to critically ill patients need to be regularly assessed to ensure that previously stated goals are well achieved as the risk of complications of oversedation is minimized. We revised and prospectively tested the Ramsay Sedation scale (RSS) for interrater reliability and compared it with the Sedation-Agitation Scale (SAS) and the Richmond Agitation Sedation Scale (RASS) to test construct validity during midazolam-remifentanil sedation. Methods: A convenience sample of ICU patients was simultaneously and independently examined by pairs of trained evaluators by using the revised SAS, RSS, and RASS. Ninety-two ICU patients were examined a total of 276 times by evaluator pairs. Results: The mean patient age was 61.32 ± 18.68 years, 45,7% were female (n = 42), 54.3% male (n = 50). Their APACHE values varied between 3 and 39 with an average of 13.27 ± 7.86 and 75% of the cases were under mechanical ventilation. When classified by using RSS (2.70 ± 1.28), 10.9% were anxious or agitated (RSS1), 68.5% were calm (RSS 2-3), and 20.6% were sedated (RSS 4-6). When classified by using RASS (-0.64 ± 1.58), 20.7% were anxious or agitated (RASS+1 to +4), 63.0% were calm (RASS 0 to -2), and 16.3% were sedated (RASS -3 to -5). When classified by using SAS (2.63 ± 1.00), 12% were anxious or agitated (SAS 5-7), 57.6% were calm (SAS 4), and 30.4% were sedated (SAS 1-3). RSS was correlated with the SAS (r = -0.656, p < 0.001) and RASS was correlated with the SAS (r = 0.565, p < 0.001). RSS was highly correlated with the RASS (r = -0.664, p < 0.001). Conclusions: Ramsay is both reliable and valid (high correlation with the RASS and SAS scales) in assessing agitation and sedation in adult ICU patients.

Resumo Justificativa e objetivos: O tratamento de pacientes em estado crítico com sedativos e analgésicos deve ser regularmente avaliado para garantir que as metas pré-definidas sejam atingidas, bem como minimizar o risco de complicações resultantes de sedação em excesso. Conduzimos uma revisão e testamos prospectivamente a Escala de Sedação de Ramsay (Ramsay Sedation Scale [RSS]) para a confiabilidade interavaliador e a comparamos com a Escala de Sedação e Agitação de Riker (Riker Sedation-Agitation Scale [RRSAS]) e a Escala de Sedação e Agitação de Richmond (Richmond Agitation Sedation Scale [RASS]) para testar a validade de construto durante a sedação com midazolam-remifentanil. Métodos: Uma amostra de conveniência de pacientes de UTI foi simultânea e independentemente examinada por pares de avaliadores treinados com o uso das escalas revisadas RRSAS, RSS e RASS. Foram examinados 92 pacientes de UTI por pares de avaliadores em 276 momentos. Resultados: A média dos pacientes foi de 61,32 ± 18,68 anos; 45,7% eram do sexo feminino (n = 42) e 54,3% do masculino (n = 50). Seus escores APACHE variaram entre 3-39, com média de 13,27 ± 7,86, e 75% dos casos receberam ventilação mecânica. Quando RSS foi usada para a classificação (2,70 ± 1,28), 10,9% dos pacientes estavam ansiosos ou agitados (RSS1), 68,5% estavam calmos (RSS 2 a 3) e 20,6% estavam sedados (RSS 4 a 6). Quando RASS foi usada para a classificação (-0,64 ± 1,58), 20,7% dos pacientes estavam ansiosos ou agitados (RASS +1 a +4), 63,0% estavam calmos (RASS 0 a -2) e 16,3% estavam sedados (RASS -3 a -5). Quando RSAS foi usada para a classificação (2,63 ± 1,00), 12% dos pacientes estavam ansiosos ou agitados (RSAS 5 a 7), 57,6% estavam calmos (RSAS 4) e 30,4% estavam sedados (RSAS 1 a 3). Houve correlação de RSS com RSAS (r = -0,656, p < 0,001) e de RASS com RSAS (r = 0,565, p < 0,001). Houve forte correlação de RSS com RASS (r = -0,664, p < 0,001). Conclusões: A RSS é confiável e válida (forte correlação com RASS e RSAS) para avaliar a sedação e agitação em pacientes adultos internados em UTI.

Benefical Effects of Sigma-1 Agonist Fluvoxamine for Tardive Dyskinesia and Tardive Akathisia in Patients with Schizophrenia: Report of Three Cases

Fluvoxamine is a selective serotonin reuptake inhibitor that is approved for psychiatric disorders such as major depressive episodes and obsessive-compulsive disorder. Beside inhibition of serotonin reuptake, fluvoxamine is also a potent agonist of endoplasmic reticulum (ER) protein sigma-1 receptors, which play a role in the pathophysiology of a number of psychiatric and neurodegenerative disorders. This report presents beneficial effects of sigma-1 agonist fluvoxamine on hyperkinetic movement disorders such as tardive dyskinesia and tardive akathisia. Fluvoxamine might be a novel treatmet approach in the treatment of hyperkinetic movement disorders.

Avaliação da indução, recuperação, agitação ao despertar e consumo com uso de duas marcas de sevoflurano para anestesia ambulatorial / Assessment of induction, recovery, agitation upon awakening, and consumption with the use of two brands of sevoflurane for ambulatory anesthesia / Evaluación de la inducción, recuperación, agitación al despertar y consumo con el uso de dos marcas de sevoflurano para la anestesia ambulatorial

JUSTIFICATIVA E OBJETIVOS: O sevoflurano por suas características farmacológicas é o anestésico ideal para procedimentos de curta duração. Existem duas marcas de sevoflurano no mercado brasileiro, o Sevocris® e Sevorane®, com diferentes formulações e envasamento. O objetivo deste estudo foi analisar se existem diferenças entre os dois anestésicos na indução, manutenção, recuperação e consumo. MÉTODO: Foram incluídas 130 crianças dividas em dois grupos segundo a marca do agente utilizado: Grupo 1 sevoflurano da Cristália® e Grupo 2 da Abbott®. Foram analisados os seguintes parâmetros: frequência cardíaca, pressão arterial sistólica e diastólica, fração inspirada e expirada de sevoflurano, valores de BIS, temperatura timpânica, tempos de indução e recuperação, agitação ao despertar pela escala PAED e consumo do anestésico por pesagem dos vaporizadores. A indução foi realizada com 1 CAM e incrementadas a cada três movimentos respiratórios em 0,5 CAM, até no máximo 3 CAM. RESULTADO: Não houve diferença entre os grupos quanto ao tempo de procedimento e de anestesia e nos parâmetros avaliados na indução. No Grupo 1, o número de crianças que necessitaram bolus adicionais de sevoflurano na manutenção da anestesia foi maior que no 2 (p < 0,05). A fração inspirada e expirada de sevoflurano no final do procedimento foi menor no Grupo 1 (p < 0,001). No momento do despertar o valor do BIS foi menor no Grupo 1 (p = 0,045). Outros parâmetros avaliados na recuperação não mostraram diferença entre os grupos. O consumo de anestésico foi semelhante entre os grupos.

BACKGROUND AND OBJECTIVES: Due to its pharmacological characteristics, sevoflurane is the ideal anesthetic for short-duration procedures. There are two brands of sevoflurane in the Brazilian market, Sevocris® and Sevorane®, with different formulations and packaging. The objective of this study was to assess whether there are differences between the two anesthetics regarding induction, maintenance, recovery, and consumption. METHODS: One hundred and thirty children were included, divided into two groups according to the brand used: Group 1 was assigned to sevoflurane Cristália® and Group 2 to sevoflurane Abbott®. The following parameters were assessed: heart rate, systolic and diastolic blood pressure, fraction of inspired and expired sevoflurane, BIS values, tympanic temperature, induction and recovery time, agitation upon awakening measured by the PAED scale, and anesthetic consumption by weighing the vaporizers. Anesthesia was induced with 1 MAC and increased every three breaths at 0.5 MAC, up to 3 MAC. RESULTS: There was no difference between groups regarding the duration of the procedure, the anesthesia, and the parameters evaluated at induction. In Group 1, the number of children who required additional bolus of sevoflurane for anesthesia maintenance was higher than in Group 2 (p < 0.05). The fraction of inspired and expired sevoflurane at the end of the procedure was lower in Group 1 (p < 0.001). Upon awakening, BIS value was lower in Group 1 (p = 0.045). Other parameters evaluated in recovery showed no difference between groups. The use of anesthesia was similar between groups.

JUSTIFICATIVA Y OBJETIVOS: El sevoflurano, por sus características farmacológicas, es el anestésico ideal para procedimientos de corta duración. Existen dos marcas de sevoflurano en el mercado brasileño, el Sevocris® y el Sevorane®, con diferentes formulaciones y envases. El objetivo de este estudio, fue analizar si existen diferencias entre los dos anestésicos en la inducción, mantenimiento, recuperación y consumo. MÉTODO: Se incluyeron 130 niños divididos en dos grupos según la marca del agente utilizado: Grupo 1 sevoflurano de Cristália® y Grupo 2 de Abbott®. Se analizaron los siguientes parámetros: frecuencia cardíaca, presión arterial sistólica y diastólica, fracción inspirada y espirada de sevoflurano, valores de BIS, temperatura timpánica, tiempos de inducción y recuperación, agitación al despertar por la escala PAED, y consumo del anestésico por pesaje de los vaporizadores. La inducción fue realizada con 1 CAM e incrementada a cada tres movimientos respiratorios en 0,5 CAM, hasta el máximo de 3 CAM. RESULTADO: No hubo diferencia entre los grupos en cuanto al tiempo de procedimiento y de anestesia y en los parámetros evaluados en la inducción. En el Grupo 1, el número de niños que necesitaron bolos adicionales de sevoflurano en el mantenimiento de la anestesia, fue mayor que en el 2 (p < 0,05). La fracción inspirada y espirada de sevoflurano al final del procedimiento fue menor en el Grupo 1 (p < 0,001). Al momento del despertar, el valor del BIS fue menor en el Grupo 1 (p = 0,045). Otros parámetros evaluados en la recuperación no arrojaron diferencia entre los grupos. El consumo de anestésico fue similar entre los grupos.

Antipsychotic-induced tardive movement disorders: a series of twelve cases.

BACKGROUND: Prolonged use of antipsychotic drugs (AP) with or without sudden withdrawal as well as high dosage of AP (at least 3 months) may result in a variety of movement disorders such as classical tardive dyskinesia (tongue rolling, lip pouting, trunkal choreiform movements), tardive myoclonus (sudden, brief involuntary jerking), tardive dystonia (tongue protrusion, torticollis, scoliosis, jaw spasm, bruxism, abnormal trunkal posture, or "Pisa syndrome", strong contraction of arm and leg). Patients with severe symptoms often suffer from body pain and fractures of bones due to frequent fallings. They are also accused of "faking" to call attention or they believe that the symptoms are signs of being "cursed or posses in". OBJECTIVE: To report twelve patients of antipsychotic drug induced tardive movement disorders including tardive dystonia, tardive myoclonus, and tardive Parkinsonism. Patients were incorrectly diagnosed as epilepsy, conversion (pseudo seizure), or hypochondriasis. RESULTS: In the present series, there were eight men and four women with age ranging from 13 to 72 years. All patients had been taking both typical and atypical antipsychotic drugs for at least one year. Strong involuntary movement disorders, torticollis, scoliosis, body pain, difficulty in swallowing, and aphonia were observed Most patients were thin and anemic. They responded well to diazepam, anticholinergic drug, clonazepam lithium, and antidepressant while antipsychotic drugs were discontinued in most cases. Calcium salt and iron supplement appeared to be useful. CONCLUSION: Physicians should be aware of these abnormal movement disorders induced by AP drugs to detect early and provide prompt treatment. AP drug should be used cautiously to prevent this iatrogenic effect particularly in high- risk patients.

[ survey on frequency of drug-induced akathisia in psychiatric wards using two methods: clinical diagnosis and Barnes rating scale]

Akathisia syndrome is one of the medication induced movement disorders that is found is patients who take neuroleptic drug. In this disorder the patients has an inner sense of restlessness and there are some restless movement in patients' limbs. Akathisia can cause drug noncompliance. To make a proper decision for treating the patients and using the best kinds of drugs, a proper rating scale for diagnosing akathisia should be determined. This cross sectional study was performed in descriptive - analytic style. Samples were 156 hospitalized patients who were on psychiatric drugs. For each patient two data collection forms were prepared. The first form involved questions about diagnosis and akathisia management by physicians. The second form involved Barnes rating scale for Akathisia [BARS]. The data analysis was performed using SPSS, tests were t-student and statistical significance was assessed at the 5% alpha level. This study was performed in Noor, Farabi and Modares hospitals in the spring and summer of 1383 [2004] in Isfahan [Iran]. Among 156 patients, akathisia was diagnosed in 15.4% by BARS scale and in 9.6% by physicians. There was significant difference between the diagnosis of Akathisia by BARS and the diagnosis by physicians. Among patients who had akathisia [in BARS], 29.2% had mild akathisia, 50% had moderate akathisia, 20.8% had marked akathisia Pseudoakathisia was diagnosed in 2.6% of 156 samples. All of the patients, who had akathisia, were taking Antipsychotic drug [83.3% Typical and 16.7% atypical antipsychotic]. For treatment, the physicians reduced the dosage of antipsychotic drugs in 80% of the akathisia patients, and added a new drug for 60% of the patients and changed the antipsychotic drug for 20% of them. In our study, akathisia was diagnosed for 24 patients by BARS. But the physicians did not diagnose akathisia in some of these patients. This might have negative effects on treatment of the patients. Therefore, it's necessary to introduce the Barns akathisia rating scale [BARS] to all physicians and encourage them to apply in all wards to suspicious cases

Akathisia--diagnostic dilemma and behavioral treatment.

Akathisia, an involuntary movement disorder resulting from exposure to antipsychotics, is characterized by subjective restlessness and a strong desire to move about. The diagnosis is often complicated by the overlapping symptoms of pseudoakathisia, chronic akathisia and tardive dyskinesia. This report deals with a patient with schizophrenia who developed akathisia after exposure to antipsychotics. Later, she developed movements that were more like pseudoakathisia and tardive dyskinesia rather than acute akathisia. On failure of anti-akathisia medication, she was treated with a behavioral regime to which her akathisia responded. This behavioral regime used the technique of distraction as a primary tool. This case report highlights the diagnostic difficulties in akathisia and the application of behavioral treatment for akathisia that is non-responsive to anti-akathisia medication.

Síndrome de discontinuación de antidepresivos / Withdrawal syndrome of antidepressants

Introducción: Considerando el amplio uso de los antidepresivos evaluamos la existencia y características del síndrome de discontinuación de antidepresivos. Métodos. Usando MEDLINE identificamos reportes y artículos de revisión relevantes acerca de síntomas secundarios al retiro de antidepresivos. Resultados. Existe amplia evidencia acerca de un síndrome de discontinuación tras el retiro de antidepresivos tricíclicos, inhibidores de la monoaminooxidasa e inhibidores de recaptura de serotonina, habiéndose descrito desde molestias leves a cuadros severos con síntomas psicóticos y agitación, siendo en general más graves los síntomas asociados a discontinuación de inhibidores de la manoamino-oxidasa y tricíclicos. Conclusiones. La información obtenida debe ser considerada por los clínicos al momento de prescribir el inicio o retiro de antidepresivos. Debe tenerse en cuenta el síndrome de discontinuación de antidepresivos en pacientes que presentan bruscas exacerbaciones sintomáticas. Se sugiere como medida preventiva la disminución gradual de las dosis antes de suspender un antidepresivo

Acatisia inducida por tietilperazina en paciente embarazada / Akathisia induced by thiethylperazine in a pregnant patient

La acatisia es un efecto lateral neurológico agudo común a diversos fármacos que actúan a nivel dopaminérgico, su manifestación fundamental es la inquietud psicomotora, es importante diagnosticar y tratar precozmente este síndrome. Tietilperazina es una fenotiazina cuyo efecto antiemético es usado en diversas circunstancias clínicas, presentamos el caso de una paciente hospitalizada por hiperemesis gravídica que es derivada a psiquiatría por la presencia de síntomas aparentemente ansiosos. El examen clínico permite sospechar acatisia por Tietilperazina Torecan®, el cuadro cede completamente con la suspensión del fármaco. Nos parece interesante comunicar este caso por la implicancia para los especialistas.

Akatisia is an common neurological complication of treatment with dopaminergic drugs, subjetive feeling of restlessness is their main symptom, it's important to recognize this syndrome early and to treat immediately. Thietylperazine is an phenothiazine drug with antiemetic effect used for medical practice, we present a case of 35 years old pregnancy inpatient referred to psychiatrist for anxiety, the diagnosis was akatisia induced by thietylperazide.

Tratamento farmacológico de acatísia induzida por antipsicóticos / Pharmacological treatment of neuroleptic-induced akathisia

Introduçäo: A acatisia por antipsicóticos é um transtorno de movimento relacionado ao sistema motor e caracterizado por sensaçäo subjetiva de inquietude interna, irritabilidade ou disforia que podem ser intensas. Associa-se à sensaçäo física e objetiva de desassossego e a movimentos näo discinéticos. Esse efeito adverso pode predispor à pobre adesäo ao tratamento e, consequentemente, favorecer recaídas. Assim, a escolha do melhor tratamento contribui para o alívio do sofrimento dos pacientes e favorece o melhor prognóstico. Objetivos: Avaliar a eficácia e a tolerabilidade dos betabloqueadores, benzodiazepínicos e anticolinérgicos, comparados ao placebo e entre si, no tratamento de acatisia induzida por antipsicóticos, independente de idade ou diagnóstico psiquiátrico. Métodos: Todos os estudos controlados, obtidos a partir das estratégias de busca que compararam betabloqueadores de açäo central, benzodiazepínicos ou anticolinérgicos ao placebo e entre si, independente de sexo, idade ou diagnóstico psiquiátrico, foram considerados para esta atualizaçäo. Até março de 1999, foram consultadas sete bases de dados eletrônicos, sendo também examinadas as referências bibliográficas dos artigos selecionados. Resultados: Säo apresentados 22 estudos controlados, sendo 13 comparando betabloqueadores, benzodiazepínicos e anticolinérgicos ao placebo e nove comparando diretamente as intervenções entre si. Conclusões: As três intervenções farmacológicas demonstraram eficácia superior comparadas ao placebo. Betabloqueadores de açäo central mostraram-se mais eficazes, quando comparados a betabloqueadores de açäo periférica, benzodiazepínicos e anticolinérgicos

Effect of leaf essential oil from Piper solmsianum C.DC. in mice behaviour

The essential oil from Piper solmsianum leaves and its major compound (sarisan) were tested to verify their influences upon mice behaviour. The essential oil was obtained by hydrodistillation in a modified Clevenger extractor and analysed by GC/ MS. This analysis revealed in the oil the presence of monoterpenes, sesquiterpenes and of arylpropanoids. The compound sarisan, a myristicin analogue, was isolated from the oil to perform the pharmacological tests. Emulsions of the oil and of sarisan (5.0 and 10.0 percent v/v) were used in the tests. Pentobarbital (30 mg/ kg s.c.) or diazepam (2.5 mg/ kg s.c.) were tested as standard drugs to verify depressant or anxiolytic effects, respectively. Both essential oil and sarisan showed to have exciting and depressant effects in the tested animals

Hipóteses fisiopatológicas e considerações terapêuticas da acatisia induzida por antipsicóticos / Pathophysiological hypothesis and therapeutic considerations of neurolepticðinduced akathisia

A fisiopatologia da acatisia induzida por antipsicóticos não está totalmente compreendida. Muitas hipóteses propostas têm demonstrado o possível envolvimento de diversas vias neuronais do sistema nervoso central, incluindo os sistemas noradrenérgico, dopaminérgico, serotoninérgico, colinérgico e gabaérgico. Os autores apresentam hipóteses fisiopatológicas e considerações terapêuticas da acatisia induzida por antipsicóticos

Acatisia secundaria a tolcapone: reporte de un caso / Akathisia secondary to tolcapone: report of a case

El propósito del presente trabajo es comunicar un caso de acatisia inducida por tolcapone. Se reporta el caso de una mujer de 39 años con enfermedad de Parkinson de 10 años de evolución, estadio IV Hoehn-Yahr y Webster 18 puntos, con mala respuesta clínica a levodopa-carbidopa, pergolida, trihexifenidilo, y selegilina, debido a presencia de fenómenos de congelamiento, wearing 0ff, y movimientos discinéticos coreicos de extremidades superiores, durante los seis meses previos a su valoración. La función hepática resultó normal, y posteriormente se redujo la cantidad de levodopa-carbidopa y selegilina, para agregar tolcapone. Las primeras tres semanas con tolcapone presentó notable mejoría de las complicaciones mencionadas manteniendo el efecto 12.5 semanas. En la 13a semana de inicio de tolcapone presenta movimientos involuntarios, constantes en cara, tronco, extremidades superiores e inferiores, asociados a incapacidad de mantener quietud motora. Exámenes de laboratorio mostraron elevación discreta de transaminasa glutámico - oxaloacética, bilirrubina directa, bilirrubina indirecta y de fosfatasa alcalina. Electroencefalograma y tomografía craneal fueron normales. Se suspendió tolcapóne, se disminuyó la cantidad de pergolida, selegílina, y levodopa-carbidopa y se mantuvo sin cambio trihexifenidilo, desapareciendo las manifestaciones de acatisia a las 72 hrs. de haber suspendido tolcapone.

Correlations between Anxious, Depressive Mood and Positive, Negative Symptoms in Chronic Schizophrenics: a Differential Relationship with the Presence of Akathisia / 신경정신의학

OBJECTIVES: In previous studies, the significant correlations between depression-anxiety symptoms and positive symptoms had been reported in schizophrenia. However, it is suggested that these correlations reflect the common influence of third variable, and akathisia-associated dysphoria may be the strong mediator of these relationships. The aim of this study is to investigate the correlations between depression-anxiety symptoms and the schizophrenic symptoms including direct measures of drug-induced akathisia. METHODS: The subjects were 57 patients with chronic schizophrenia. All patients were functioning cognitively at a level to understand and complete the several self-report inventories. Akathisia was rated using Barnes akathisia rating scale (BARS), and depression-anxiety symptoms were assessed by two self-report measures, Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). The symptoms of schizophrenia were assessed using Manchester Scale. RESULTS: In the whole group of subjects, the scores on BDI and dysphoria composite index were significantly correlated with total positive symptom scores and all subscale scores of positive symptoms. In akathisia group, the scores on BDI and dysphoria composite index were still significantly correlated with total positive symptom scores and the subscale scores of delusion. In non-akathisia group, however, there were no significant correlations between self-report depression, anxiety symptoms and total positive symptom scores. CONCLUSION: These results suggest that the akathisia is the important factor in correlations between dysphoric symptoms and positive symptoms. Therefore, the caution is necessary in the interpretation of previous studies which report the direct correlations between depression and positive symptoms. Future research is needed to investigate the associations in akathisia, depression, and the schizophrenic symptom complexes.

Desórdenes del movimiento inducidos por drogas / Drug-induced movement disorders

Las drogas antagonistas de los receptores de dopamina pueden inducir movimientos anormales que eventualmente siguen un curso, crónico. La variedad más conocida es el síndrome de estereotipias orolinguales pero también se presentan acatisia y distonia tardía, tics, estereotipias y manierismos, así como temblor y síndrome hipocinético-rígidos (parkinsonismo). Presentamos la fenomenología clínica de estos síndromes motores, aproximaciones a su tratamiento