Question:medium
A schizophrenia patient on haloperidol was responding well for the last 2 years. Now he presents with orofacial dyskinesia, choreiform, tic-like movements, and dystonia features. What can be the probable diagnosis and treatment?
A schizophrenia patient on haloperidol was responding well for the last 2 years. Now he presents with orofacial dyskinesia, choreiform, tic-like movements, and dystonia features. What can be the probable diagnosis and treatment?
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Long-term antipsychotic use with orofacial involuntary movements = tardive dyskinesia; treatment includes valbenazine.
Updated On: May 14, 2026
- Acute dystonia -- Ropinirole
- Tardive dyskinesia -- Valbenazine
- Akathisia -- Propranolol
- Oral tremor -- Amantadine
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The Correct Option is B
Solution and Explanation
Step 1: Understanding the Question:
The question describes a patient who developed involuntary movements after long-term (2 years) treatment with a typical antipsychotic (Haloperidol), requiring a diagnosis of the specific Extrapyramidal Side Effect (EPS).
Step 2: Detailed Explanation:
Tardive Dyskinesia (TD): This is a late-onset (hence "tardive") side effect of chronic dopamine blockade. It typically presents as repetitive, involuntary, purposeless movements, most commonly involving the face (tongue protrusion, lip-smacking, grimacing).
Pathophysiology: It is thought to be caused by upregulation and supersensitivity of \(D_2\) receptors in the striatum after prolonged blockade.
Treatment - Valbenazine: Valbenazine and Deutetrabenazine are selective VMAT2 (Vesicular Monoamine Transporter 2) inhibitors. They work by reducing the amount of dopamine packaged into vesicles, thereby lowering the synaptic release of dopamine and suppressing the dyskinetic movements.
Why others are incorrect: Acute dystonia (Option A) occurs within hours to days of starting a drug and is treated with anticholinergics. Akathisia (Option C) is a subjective feeling of inner restlessness. Tardive dyskinesia is a chronic condition that does not resolve by simply stopping the drug and often requires specific therapy.
Step 3: Final Answer: The presentation of orofacial movements after years of haloperidol use is characteristic of Tardive Dyskinesia, and Valbenazine is the FDA-approved first-line treatment.
The question describes a patient who developed involuntary movements after long-term (2 years) treatment with a typical antipsychotic (Haloperidol), requiring a diagnosis of the specific Extrapyramidal Side Effect (EPS).
Step 2: Detailed Explanation:
Tardive Dyskinesia (TD): This is a late-onset (hence "tardive") side effect of chronic dopamine blockade. It typically presents as repetitive, involuntary, purposeless movements, most commonly involving the face (tongue protrusion, lip-smacking, grimacing).
Pathophysiology: It is thought to be caused by upregulation and supersensitivity of \(D_2\) receptors in the striatum after prolonged blockade.
Treatment - Valbenazine: Valbenazine and Deutetrabenazine are selective VMAT2 (Vesicular Monoamine Transporter 2) inhibitors. They work by reducing the amount of dopamine packaged into vesicles, thereby lowering the synaptic release of dopamine and suppressing the dyskinetic movements.
Why others are incorrect: Acute dystonia (Option A) occurs within hours to days of starting a drug and is treated with anticholinergics. Akathisia (Option C) is a subjective feeling of inner restlessness. Tardive dyskinesia is a chronic condition that does not resolve by simply stopping the drug and often requires specific therapy.
Step 3: Final Answer: The presentation of orofacial movements after years of haloperidol use is characteristic of Tardive Dyskinesia, and Valbenazine is the FDA-approved first-line treatment.
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