Sedation and mental clouding may be implicated in social withdrawal, but their severity may be underestimated by psychiatrists. Natalia Jimeno, in Side Effects of Drugs Annual, 2010 Nervous system This reaction was probably caused by the risperidone, and the role of lithium was not clear.Īlfonso Carvajal. Ĭo-administration of lithium and risperidone has been associated with the rabbit syndrome. Ī 38-year-old man with major depressive disorder and psychotic features developed rabbit syndrome after taking risperidone 4 mg/day and paroxetine 40 mg/day for 4 months he was also taking simvastatin 10 mg/day, thiamine 100 mg/day, and folic acid 1 mg/day. #RABBIT SYNDROME FRIPSIDE NAO PROJECT RAR TRIAL#Within days, there was symptomatic improvement, but a trial withdrawal of the anticholinergic drug resulted in worsening of the symptoms and treatment was renewed. The dosage of risperidone was reduced to 2 mg/day and an anticholinergic drug was added. These movements were accompanied by a strange, irritating, involuntary popping sound. Ī 27-year-old man took risperidone 6 mg/day and after 4 months the dosage was reduced to 4 mg/day 7 months after the start of treatment he developed fine rapid pouting and puckering of the lips.Rabbit syndrome has been reported in patients taking risperidone. The jaw tremor of Parkinson's disease (which some authors refer to also as RS) and oral stereotypes seen in the elderly and edentulous should be included in the differential diagnosis. Unlike oral tardive dyskinesia, RS cannot be suppressed voluntarily. Tardive dyskinesia with oral movements resembles chewing and smacking of the lips, whereas RS is a perioral tremor typical of parkinsonism. The speed and rhythmicity of the movements may help to distinguish the two, as RS is faster and more rhythmic than the movements of oral tardive dyskinesia. An additional clue to the diagnosis of RS is that unlike oral tardive dyskinesia, the lip movements are restricted to the vertical plane in RS. The tongue is uninvolved in RS and displays no abnormal movements. One key to differentiating the syndromes is to examine the tongue. The most common misdiagnosis of RS is oral tardive dyskinesia. Timing of the onset of RS after exposure to antipsychotics is variable, with RS starting in as little as a week after initiation of drug to years after start of therapy. The worsening of the movements can occur during tasks of attention or concentration. Fatigue and anxiety can worsen the movements of RS. In contrast to tardive dyskinesia, the movements of RS continue during stage I sleep. Not surprisingly, patients may have findings of parkinsonism, including rigidity, bradykinesia, and tremor. There can be an associated popping sound produced by the opening and closing of the lips. The movements are rhythmic with a frequency of ∼5 Hz. RS is a rhythmic movement involving the mouth with a highly recognizable appearance that consists of vertical movements of the mouth and lips, which spare the tongue. Weiner, in Encyclopedia of Movement Disorders, 2010 Clinical Features and Differential Diagnosis
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