Case Study: Assessment and Management of Medication Induced (DULOXETINE) Abnormal Involuntary Movements

The awareness of the occurrence of mental health illness in younger age group has substantially increased in recent years, consequently so have the prescriptions of psychotropic medications at midlevel, primary care and specialty care level. In any given month in most cities in the USA which have an active Pharmaceutical representative community, practitioners are exposed to branded information studies talking about the benefits of second generation atypical psychotropic medications. Also being highlighted is their proposed role in numerous mental health diagnosis, from Schizophrenia, to Depression, to Autism, to various phases of Bipolar Disorder. It is acknowledged that the pharmaceutical agents available today are vastly superior in their effectiveness (both efficacy and tolerability) as compared to their predecessors (first generation/Typical Anti -psychotics), however this piece of information should not cause the Doctors and Practitioners to lower their guard when it comes to judicious and appropriate use of such pharmaceutical agents. Various side-effects are discussed in Package Inserts, as well as print and electronic versions of prescribing aids and tools including, PDR, Epocrates etc. Despite the fact that they are not very common, the risk of movement disorders should be cautiously evaluated before prescribing or augmenting with anti-psychotic medications, and monitoring of abnormal movements needs to be done more frequently. Another very important factor to consider is the fact that due to overwhelming shortage of Trained Psychiatrist, and the phenomenal increase in the mental health needs in children, adolescent and adults (young and old), therefore those non-psychiatric Prescribers who prescribe Psychiatric Medications, including Primary Care, Family Practice and Pediatric Physician, as well as mid-level providers (Nurse Practitioners and Physician Assistants) should be trained more thoroughly with more exposure and supervised training according to current guidelines. The following case brings to light the complexities of assessing and then managing medication induced Abnormal Involuntary Movements. ment was initiated with LORAZEPAM, NEURONTIN, COGENTIN and VITAMIN-E. The patient tolerated the regime. The response to treatment as evidenced by amelioration of symptoms was slow but noticeable. By the end of six months there was no observable abnormal involuntary movement.