An acute dystonic reaction consists of sustained, often painful muscular spasms, producing twisting abnormal postures. 50% occur within 48 hours of initiation of the neuroleptic. 90% occur within 5 days. These reactions are more common with parental then oral medications. They're more common in the younger patients, and more common in males than females in the young age group.
Approximately 3 to 10% of patients exposed to neuroleptics will experience an acute dystonic reaction. Haldol and the long acting. injected fluphenazines have the highest incidence of these reactions. The risk is higher in patients with a prior history of a similar reaction or a family history of dystonia. The order of the most frequent types include neck dystonia 30%, tongue dystonia 17%, jaw dystonia 15%, oculorgyric crisis (eyes rolling back, and neck arching) 6%, and opisthotonus (body arching) 3.5%. The movements than may fluctuate over hours and temporarily abate in response to reassurance. This can cause an inappropriate diagnosis of hysteria. They typically last minutes to hours without treatment. Occasionally the movements are more choreiform. They are more typically generalized in young patients and more focal in the older patients.
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