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

• Chung IW
• Kim I
• Youn T
• Jeong SH
• Jung HY
• Kim YS

• KMID: 2410775
• DOI: http://doi.org/10.16946/kjsr.2018.21.1.9

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

Reference

1. Watanabe K. The syndromes of oculogyric crisis and paroxysmal perceptual alteration in chronic schizophrenic patients--a clinical inquiry into their pathophysiology. Seishin Shinkeigaku Zasshi. 1991; 93:151–189.

2. Watanabe K. Paroxysmal perceptual alteration in comparison with hallucination--a review of its clinical reports and discussion of its pathophysiological mechanism in the present day, when second generation antipsychotics are widely used. Seishin Shinkeigaku Zasshi. 2009; 111:127–136.

3. Abe K. Psychiatric symptoms associated with oculogyric crisis: a review of literature for the characterization of antipsychotic-induced episodes. World J Biol Psychiatry. 2006; 7:70–74.

4. Jeong HY, Ahn YM, Kim YS. Chap 3. Physiologic and psychologic side effects of antipsychotics. III. Psychologic side effects. 2. Paroxysmal perceptual alteration. In : Kim YS, editor. Pharmacological Treatment of Schizophrenia. Seoul: Ilchokak;1998. p. 70–71.

5. Barow E, Schneider SA, Bhatia KP, Ganos C. Oculogyric crises: Etiology, pathophysiology and therapeutic approaches. Parkinsonism Relat Disord. 2017; 36:3–9.

6. Oeckinghaus W. Encephalitis epidemica und Wilsonsches Krankheitsbild. Dtsch Z Nervenkr. 1921; 72:294–309.

7. Cheney G, Martins S. Postencephalitic paroxysmal oculogyric crises: report of cases. Cal West Med. 1930; 33:724–728.

8. Berger JR, Vilensky JA. Encephalitis lethargica (von Economo's encephalitis). Handb Clin Neurol. 2014; 123:745–761.

9. Leigh RJ, Foley JM, Remler BF, Civil RH. Oculogyric crisis: a syndrome of thought disorder and ocular deviation. Ann Neurol. 1987; 22:13–17.

10. Slow EJ, Lang AE. Oculogyric crises: a review of phenomenology, etiology, pathogenesis, and treatment. Mov Disord. 2017; 32:193–202.

11. Barton JJS, Cox TA, Calne DA. Involuntary ocular deviations and generalized dystonia in multiple sclerosis: a case report. J Neuro-Ophthalmolog. 1994; 14:160–162.

12. Kakigi R, Shibasaki H, Katafuchi Y, Iyatomi I, Kuroda Y. The syndrome of bilateral paramedian thalamic infarction associated with an oculogyric crisis. Rinsho Shinkeigaku. 1986; 26:1100–1105.

13. Matsumura K, Sakuta M. Oculogyric crisis in acute herpetic brainstem encephalitis. J Neurol Neurosurg Psychiatry. 1987; 50:365–366.

14. Furumoto H, Kitano K, Wang DS, Matsumoto S, Moroo I. Oculogyric crisis as an initial symptom of juvenile parkinsonism-like disease. Rinsho Shinkeigaku. 1989; 29:1287–1289.

15. Sachdev P. Tardive and chronically recurrent oculogyric crises. Mov Disord. 1993; 8:93–97.

16. Bickerstaff ER, Jacoby E. Oculogyric crises with phenothiazine derivatives. Br Med J. 1960; 1:647.

17. Burke R, Fahn S, Jankovic J, Marsden C, Lang A, Gollomp S. Tardive dystonia: late-onset and persistent dystonia caused by antipsychotic drugs. Neurology. 1982; 32:1335–1346.

18. Gupta R, Balhara Y. Antipsychotic induced chronic recurrent oculogyric crisis in a patient with obsessive compulsive disorder. Psychopharmacology. 2014; 231:3065–3066.

19. Sachdev P, Tang WM. Psychotic symptoms preceding ocular deviation in a patient with tardive oculogyric crises. Aust N Z J Psychiatry. 1992; 26:666–670.

20. FitzGerald PM, Jankovic J. Tardive oculogyric crises. Neurology. 1989; 39:1434–1437.

21. Yamaguchi N, Nakai H. Attacks of altered perception in schizophrenics. In : Uchiyama Y, editor. Psychopathology of schizophrenia. Tokyo (Japan): Tokyo University Press;1985. p. 295–314.

22. Higuchi H, Shimizu T, Hishikawa Y. Recurrent episodes of altered perceptions accompanied with or without acute dystonia in two schizophrenic patients. Seishin Igaku. 1988; 30:1213–1219.

23. Higuchi H, Shimizu T, Hishikawa Y. Recurrent paroxysmal episodes characterized by perceptual alteration in three schizophrenic patients on neuroleptic medication. Psychiatry Clin Neurosci. 1997; 51:99–101.

24. Simpson GM, Varga E, Haher EJ. Psychotic exacerbations produced by neuroleptics. Dis Nerv Syst. 1976; 37:367–369.

25. Uchida H, Suzuki T, Tanaka KF, Watanabe K, Yagi G, Kashima H. Recurrent episodes of perceptual alteration in patients treated with antipsychotic agents. J Clin Psychopharmacol. 2003; 23:496–499.

26. Yamashita S, Miyaoka T, Nagahama M, Ieda M, Tsuchie K, Wake R, et al. Treatment of paroxysmal perceptual alteration in catatonic schizophrenia by switching to aripiprazole from risperidone: A case report. Clin Schizophr Relat Psychoses. 2016; 10:37–40.

27. Uchida H, Suzuki T, Watanabe K, Kashima H. Antipsychotics-induced hyper-sensitivity of visual perception. Eur Psychiatry. 2006; 21:343–344.

28. Pariwatcharakul P, Ketumarn P. Antipsychotic-induced paroxysmal perceptual alteration in a patient with major depressive disorder. Psychiatry Clin Neurosci. 2009; 63:429–430.

29. Nakajima S, Suzuki T, Uchida H, Watanabe K, Kashima H. Antipsychotic-induced paroxysmal perceptual alteration in a patient with bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2009; 33:160–161.

30. Kondo M, Ikejiri Y, Hanatani T, Sumi N. Disappearance of paroxysmal perceptual alteration by switching to aripiprazole in a schizophrenic patient. Seishin Shinkeigaku Zasshi. 2010; 112:23–30.

31. Praharaj SK, Sreejayan K, Acharya M. Paroxysmal perceptual alteration: drug-induced phenomenon or schizophrenic psychopathology? Psychopharmacol Bull. 2012; 45:44–47.

32. Swett C. Drug-induced dystonia. Am J Psychiatry. 1975; 132:532–534.

33. Schneider SA, Udani V, Sankhla CS, Bhatia KP. Recurrent acute dystonic reaction and oculogyric crisis despite withdrawal of dopamine receptor blocking drugs. Mov Disord. 2009; 24:1226–1229.

34. Gardner DM, Abidi S, Ursuliak Z, Morrison J, Teehan MD, Tibbo PG. Incidence of oculogyric crisis and long-term outcomes with second-generation antipsychotics in a first-episode psychosis program. J Clin Psychopharmacol. 2015; 35:715–718.

35. Ayd FJ Jr. A survey of drug-induced extrapyramidal reactions. JAMA. 1961; 175:1054–1060.

36. Thornton A, McKenna PJ. Acute dystonic reactions complicated by psychotic phenomena. Br J Psychiatry. 1994; 164:115–118.

37. Sacks OW, Kohl M. L-dopa and oculogyric crises. Lancet. 1970; 2:215–216.

38. Abe K. Antipsychotic medications can induce transient psychotic episodes without oculogyric crises. J Nerv Ment Dis. 2004; 192:164–166.

39. Wyllie E, Luders H, Morris HH, Lesser RP, Dinner DS. The lateralizing significance of versive head and eye movements during epileptic seizures. Neurology. 1986; 36:606–611.

40. Jankovic J, Stone L. Dystonic tics in patients with Tourette’s syndrome. Mov Disord. 1991; 6:248–252.

41. Jelliffe SE. Psychologic components in postencephalitic oculogyric crises: contributions to a genetic interpretation of compulsive phenomena. Arch Neurol Psychiatr. 1929; 21:491–532.

42. McCowan PK, Cook LC. Oculogyric crises in chronic epidemic encephalitis. Brain. 1928; 51:285–309.

43. Klawans HL, Wiener WJ. Muscle stiffness and muscle pain. Clin Ther. 1981; 4:62–72.

44. Benjamin S. Oculogyric crisis. In : Joseph AB, Young RR, editors. Movement disorders in neurology and neuropsychiatry. Malden: Blackwell Science;1999. p. 93–103.

45. Chiu LPW. Transient recurrence of auditory hallucinations during acute dystonia. Br J Psychiatry. 1989; 155:110–113.

46. Rogers DGC. Oculogyric crises and schizophrenia. Br J Psychiatry. 1989; 155:569–570.

47. Tan CH, Chiang PC, Ng LL, Chee KT. Oculogyric spasm in Asian psychiatric in-patients on maintenance medication. Br J Psychiatry. 1994; 165:381–383.

48. Mazurek MF, Rosebush PI. Circadian pattern of acute, neuroleptic-induced dystonic reactions. Am J Psychiatry. 1996; 153:708–710.

49. Sachdev P. Tardive oculogyric crisis and obsessional thoughts. Br J Psychiatry. 1991; 158:720–721.

50. Nagayama H. Influences of biological rhythms on the effects of psychotropic drugs. Psychosom Med. 1999; 61:618–629.

51. Ouvrier RA. Progressive dystonia with marked diurnal fluctuation. Ann Neurol. 1978; 4:412–417.

52. Fahn S. Concept and classification of dystonia. Adv Neurol. 1988; 50:1–8.

53. Shapiro DA, Renock S, Arrington E, Chiodo LA, Liu LX, Sibley DR, et al. Aripiprazole, a novel atypical antipsychotic drug with a unique and robust pharmacology. Neuropsychopharmacology. 2003; 28:1400–1411.

54. Uchida H, Suzuki T, Yamazawa R, Tomita M, Nemoto T, Kimura Y, et al. Reducing the dose of antipsychotic agents ameliorates visual hypersensitivity attack: an ideal treatment option in terms of the adverse effect. J Clin Psychopharmacol. 2006; 26:50–55.

55. Wouts J. Questionnaire for psychotic experiences. Available from: http://qpeinterview.com/.

56. Magarinos M. Prevalence of paroxysmal perceptual alterations with antipsychotics. Poster. In : APA 2005 Annual Meeting; Atlanta. USA. NR284.

57. Uchida H, Suzuki T, Watanabe K, Yagi G, Kashima H. Antipsychotic-induced paroxysmal perceptual alteration. Am J Psychiatry. 2003; 160:2243–2244.

58. Fukuzako H, Hokazono Y, Takenouchi K, Matwinoto K, Takigdwa M, Kodaina Y. Neuroleptic-induced paroxysmal perceptual alteration in a patient with manic-depressive psychosis. Seishin Igaku. 1994; 36:759–761.

59. Ida Y, Hasegawa K. A case of manic-depressive psychosis with frequent attacks of altered perception induced by haloperidol treatment. Seishinka chiryogaku. 1995; 10:413–418.

60. Praharaj SK, Arora M, Ray P. Antipsychotic-induced paroxysmal perceptual alteration. Clin Neuropharmacol. 2008; 31:184–186.

61. Kocha H, Harima H. Genera and types of illnesses: The rule of classification of mental disorders. Jpn J Psychopathol. 2010; 31:7–17.

62. Oyebode F. Preface to the 5th edition, Sim's symptoms in the mind. 5th ed. Saunders;2015.

63. American Psychiatic Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington DC: American Psychiatric Association;2013.

64. Desmarais JE, Beauclair L, Margolese HC. Anticholinergics in the era of atypical antipsychotics: short-term or long-term treatment? J Psychopharmacol. 2012; 26:1167–1174.

65. Ogino S, Miyamoto S, Miyake N, Yamaguchi N. Benefits and limits of anticholinergic use in schizophrenia: focusing on its effect on cognitive function. Psychiatry Clin Neurosci. 2014; 68:37–49.

66. Kim YS, Choi HJ. Prevalence of tardive dyskinesia. Seoul J Med. 1982; 23:90–99.

67. Kim YS, Kim CH. Prevalence of tardive dyskinesia (II). Neuropsychiatry. 1982; 21:643–649.

68. Carbon M, Hsieh CH, Kane JM, Correll CU. Tardive dyskinesia prevalence in the period of second-generation antipsychotic use: a meta-analysis. J Clin Psychiatry. 2017; 78:e264–e278.

69. Ryu S, Yoo JH, Kim JH, Choi JS, Baek JH, Ha K, et al. Tardive dyskinesia and tardive dystonia with second-generation antipsychotics in non-elderly schizophrenic patients unexposed to firstgeneration antipsychotics: a cross-sectional and retrospective study. J Clin Psychopharmacol. 2015; 35:13–21.

70. Kim CH, Kim YJ, Kim YS. A study on tardive dyskinesia in antipsychotics-medicated bipolar patients. Seoul J Psychiatry. 1989; 14:133–142.

71. Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Beaulieu S, Alda M, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guideline for the management of patients with bipolar disorder: update 2013. Bipolar Disord. 2013; 15:1–44.

72. Tohen M, Ng-Mak D, Rajagopalan K, Halpern R, Chuang CC, Loebel A. Patient characteristics associated with use of lurasidoen versus other atypical antipsychotics in patients with bipolar disorder: analysis form a claims database in the United States. Prim Care Companion CNS Disord. 2017; 19:16m02066.

73. Yu X, Correll CU, Xiang UT, Xu Y, Huang J, Yang F, et al. Efficacy of atypical antipsychotics in the management of acute agitation and aggression in hospitalized patients with schizophrenia or bipolar disorder: results from a systematic review. Shanghai Arch Psychiatry. 2016; 28:241–252.

74. Morrison AP, French P, Stewart SLK, Birchwood M, Fowler D, Gumley AI, et al. Early detection and intervention evaluation for people at risk of psychosis: multisite randomised controlled trial. BMJ. 2012; 344:e2233.

75. Stain HJ, Mawn L, Common S, Pilton M, Thompson A. Research and practice for ultra-high risk for psychosis: a national survey of early intervention in psychosis services in England. Early Interv Psychiatry. 2017; DOI: 10.1111/eip.12443.

76. Bergman H, Walker DM, Nikolakopoulou A, Soares-Weiser K, Adams CE. Systematic review of interventions for treating or preventing antipsychotic-induced tardive dyskinesia. Health Technol Assess. 2017; 21:1–218.

77. Praharaj SK, Jana AK, Sarkar S, Sinha VK. Olanzapine-induced tardive oculogyric crisis. J Clin Psychopharmacol. 2009; 29:604–606.

78. Ghosh S, Dhrubajyoti B, Bhattacharya A, Roy D, Saddichha S. Tardive oculogyric crisis associated with quetiapine use. J Clin Psychopharmacol. 2013; 33:266.

79. Mendhekar DN, Lohia D, Kataria P. Tardive oculogyric crisis associated with amisulpride monotherapy. J Postgrad Med. 2010; 56:305–306.

80. Uzun O, Doruk A. Tardive oculogyric crisis during treatment with clozapine: report of three cases. Clin Drug Investig. 2007; 27:861–864.

81. Praharaj SK, Samal A, Sarkhel S, Sinha VK. Clozapine-induced persistent paroxysmal perceptual alteration. Prog Neuropsychopharmacol Biol Psychiatry. 2010; 34:1151–1152.

82. Fernandez HH, Friedman JH. Classification and treatment of tardive syndromes. Neurologist. 2003; 9:16–27.

83. Kulkarni SK, Naidu PS. Pathophysiology and drug therapy of tardive dyskinesia: current concepts and future perspectives. Drugs Today (Barc). 2003; 39:19–49.

84. Frucht SJ. Treatment of movement disorder emergencies. Neurotherapeutics. 2014; 11:208–212.

85. van Harten PN, Hoek HW, Kahn RS. Acute dystonia induced by drug treatment. BMJ. 1999; 3139:623–626.

86. Cortese L, Pourcher-Bouchard E, Williams R. Assessment and management of antipsychotic-induced adverse events. Can J Psychiatr. 1998; 43:15S–20S.

87. Lee AS. Treatment of drug-induced dystonic reactions. JACEP. 1979; 8:453–457.

88. Termsarasab P, Thammongkolchai T, Frucht SJ. Medical treatment of dystonia. J Clin Movement Dis. 2016; 3:19.

89. Bhoopathi PS, Soares-Weiser K. Benzodiazepines for neurolepticinduced tardive dyskinesia. Cochrane Database Syst Rev. 2006; 19:CD000205.

90. Thaker GK, Nguyen JA, Strauss ME, Jacobson R, Kaup BA, Tamminga CA. Clonazepam treatment of tardive dyskinesia: A practical GABAmimetic strategy. Am J Psychiatry. 1990; 147:445–451.

91. Freudenreich O, Remington G. Valbenazine for tardive dyskinesia. Clin Schizophr Relat Psychoses. 2017; 11:113–119.

92. Meyer JM. Forgotten but not gone: new developments in the understanding and treatment of tardive dyskinesia. CNS Spectr. 2016; 21:16–23.

93. Hauser RA, Factor SA, Marder SR, Knesevich MA, Ramirez PM, Jimenez R, et al. KINECT 3: A Phase 3 Randomized, Double-Blind, Placebo-Controlled Trial of Valbenazine for Tardive Dyskinesia. Am J Psychiatry. 2017; 174:476–484.

94. Factor SA, Friedman JH. The emerging role of clozapine in the treatment of movement disorders. Mov Disord. 1997; 12:483–496.

95. Spivak B, Mester R, Abesgaus J, Wittenberg N, Adlersberg S, Gonen N, et al. Clozapine treatment for neuroleptic-induced tardive dyskinesia, parkinsonism, and chronic akathisia in schizophrenic patients. J Clin Psychiatry. 1997; 58:318–322.

96. Chakraborty R, Chatterjee A. Clozapine-induced oculogyric crises. Ann Pharmacother. 2007; 41:1916.

97. Nebhinani N, Avasthi A, Modi M. Oculogyric crisis with clozapine: a case report and review of similar case reports in the literature. Indian J Psychol Med. 2015; 37:342–344.

98. Bassitt DP, Louzã Neto MR. Clozapine efficacy in tardive dyskinesia in schizophrenic patients. Eur Arch Psychiatry Clin Neurosci. 1998; 248:209–211.

99. Louzã MR, Bassitt DP. Maintenance treatment of severe tardive dyskinesia with clozapine 5 years' follow-up. J Clin Psychopharmacol. 2005; 25:180–182.

100. Rana AQ, Chaudry ZM, Blanchet PJ. New and emerging treatments for symptomatic tardive dyskinesia. Drug Des Develop Ther. 2013; 7:1329–1340.

101. Pinniniti NR, Faden J, Adityanjee A. Are second-generation antipsychotics useful in tardive dystonia? Clin Neuropharmacol. 2015; 38:183–197.

102. Selfani K, Soland VL, Chouinard S, Huot P. Movement disorders induced by the “atypical” antipsychotic aripiprazole. Neurologist. 2017; 22:24–28.

103. Chen YW, Tseng PT. A review of differences in clinical characteristics between tardive syndrome induced or improved by aripiprazole treatment. Acta Neurol Taiwan. 2016; 25:88–94.

104. Porcelli S, Balzarro B, Serretti A. Clozapine resistance: augmentation strategies. Eur Neuropsychopharmacol. 2012; 22:165–182.

105. Hwang SS, Jung DC, Ahn YM, Kim SH, Kim YS. The effects of psychopathology on subjective experience of side effects of antipsychotics in patients with schizophrenia. J Clin Psychopharmacol. 2010; 25:83–90.