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During the admission process, the patient became verbally and physically aggressive, belligerent, and agitated as he asked to be discharged. He also reports perceptual disturbances including auditory hallucinations telling him to kill himself. The patient endorses opioid dependence with at least three overdoses in the past. The context of the patient’s psychiatric decompensation included the anniversary of the death of his father who died two years earlier. The patient he had only recently cut his own wrist a few days before admission. The patient endorses recurrent depressive moods, poor sleep, persistent feelings of guilt, low energy, feelings of hopelessness and persistent suicidal ideations. He was brought into the psychiatric emergency room by emergency services on account of a reported suicidal attempt. We present the case of a 34-year-old man with a past medical history of seizure disorder and a psychiatric history of Attention Deficit Hyperactivity Disorder (ADHD) and Bipolar disorder. Although ADR is commonly reported, temporomandibular joint dislocations from same is rare and only reported in a few case reports. Potential risk factors for dystonia include young males, a history of dystonia and recent cocaine use or abuse. The reported incidence of ADRs is variable, but estimates are between 2.5-10%.
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The tendency for these class of drugs to produce EPS has made atypical antipsychotics the first line choice treatment for schizophrenia. ADR is regarded as the most disturbing and with a potential to be life threatening as it may result in laryngeal dystonias. Acute Dystonic Reaction (ADR) is a well-known extrapyramidal adverse effect of Haloperidol and other antipsychotics particularly FGAs. EPS include acute dystonic reactions, parkinsonian syndrome, akathisia, tardive dyskinesia, and neuroleptic malignant syndrome. Despite its propensity to cause Extrapyramidal Symptoms (EPS), Haloperidol is frequently prescribed to treat psychotic disorders, tics, bipolar disorder, delirium and to control severe behavior problems in adults and in children. It is available in the oral, intramuscular immediate release, decanoate and intravenous formulations. Haloperidol is a butyrophenone First-Generation Antipsychotic (FGA) that non-selectively blocks postsynaptic dopaminergic D 2 receptors.
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