Acute dystonia associated with antipsychotic use presents with which symptoms?

• A. Numbness in fingers
• B. Increased appetite
• C. Severe rash
• D. Muscle spasms of face, tongue, neck, and back

Answer: (D)

Acute dystonia is an extrapyramidal side effect caused by dopamine D2 receptor blockade in the nigrostriatal pathway from antipsychotic drugs. This produces sudden, painful, sustained muscle contractions, most noticeably in the muscles of the face, tongue, neck, and back, leading to grimacing, twisting of the neck (tocal or torticollis), jaw spasm, or other abnormal postures. These symptoms typically appear soon after starting or increasing the antipsychotic dose, within hours to a few days. The other options describe different types of effects not related to dystonia: numbness in fingers is a sensory issue, increased appetite reflects metabolic effects, and a severe rash is a skin reaction. The pattern of muscle spasms in the facial regions and neck is the hallmark of acute dystonia. If it occurs, treatment with an anticholinergic such as benztropine or diphenhydramine can rapidly relieve the symptoms.