Korean J Schizophr Res.  2018 Apr;21(1):9-20. 10.16946/kjsr.2018.21.1.9.

Antipsychotic-Induced Oculogyric Crisis and Paroxysmal Perceptual Alteration

Affiliations
  • 1Department of Psychiatry, Dongguk University International Hospital, Goyang, Korea. kys@snu.ac.kr
  • 2Institute of Clinical Psychopharmacology, Dongguk University College of Medicine, Goyang, Korea.
  • 3Department of Psychiatry, Keyo Hospital, Uiwang, Korea.
  • 4Department of Psychiatry, Eulji University Hospital, Daejeon, Korea.
  • 5Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, Korea.
  • 6Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Korea.
  • 7Institute of Human Behavioral Medicine, Seoul National University College of Medicine, Seoul, Korea.

Abstract

During antipsychotic drug treatment, clinicians occasionally encounter sudden attacks of oculogyric crisis (OGC) and/or paroxysmal perceptual alteration (PPA) which occur mostly in the afternoon or early evening lasting for minutes to hours and are eventually remitted with rests or short sleep and/or medications such as benzodiazepines, anticholinergics and so forth. Moreover, these attacks are usually accompanied with psychiatric symptoms such as various modalities of hallucinations and illusions, delusions, obsessive thoughts, panic attacks, agitation as well as autonomic symptoms. These accompanying psychiatric symptoms can be perceived as a worsening of psychiatric symptoms if the clinician does not understand the symptoms due to the side effects of antipsychotic drugs, which may result in increasing the dosage of antipsychotics instead of reducing doses or switching to less offending drugs. On the other hand, patients could easily recognize the symptoms as the adverse effects of drugs. This literature review and case-series study is aimed to raise awareness of OGC and PPA by providing clinical cases and author's views with the literature reviews about concepts, recognitions and managements from the works of Japanese authors who first reported the clinical importance of these attacks, particularly PPA.

Keyword

Schizophrenia; Antipsychotics; Oculogyric crisis; Paroxysmal perceptual alteration

MeSH Terms

Antipsychotic Agents
Asian Continental Ancestry Group
Benzodiazepines
Cholinergic Antagonists
Delusions
Dihydroergotamine
Hallucinations
Hand
Humans
Illusions
Panic Disorder
Schizophrenia
Antipsychotic Agents
Benzodiazepines
Cholinergic Antagonists
Dihydroergotamine
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