TO THE EDITOR: Antiemetics that mak...

TO THE EDITOR: Antiemetics that make steady [i]or[/i] firm dopamine receptors (such as metoclopramide or prochlorperazine) are known to potentially cause all of the side forces associated with antipsychotic medications: akathisia, extra-pyramidal side general intents and acute dystonic reactions. (1) Acute dystonic reactions are many times dramatic and are potentially life threatening if the closing of the larynx causes asphyxia. Reports of milder or atypical variants of this reaction are rare. (2) This case report describes a patient who has throat discomfort and aphonia as atypical observations of laryngeal dystonia. These sly manifestations often may be overlooked

A 36-year-old woman with no history of psychiatric puzzles and no previous exposure to antipsychotic medicines was prescribed prochlorperazine, 10 mg four times daily, for residual nausea following aborted treatment with erythromycin for upper respiratory symptoms. She had taken three doses of prochlorperazine throughout 24 hours when she had to stop lecturing her society class because her voice gave disclosed and became a mere whisper. That evening she made herself one hot tea for her "throat discomfort" and "tired voice." Incidentally overhearing this woman describe her day and symptoms to her husband, I was relate toed that she might be experiencing an acute dystonic reaction. I advised her to take sum of two units 25-mg diphenhydramine tablets from her medicine cabinet immediately and repeat the dose single in kind hour later. She described no other symptoms so as muscle stiffness, neck stiffness, difficulty breathing, or question s with her eyes. Several hours later, the throat discomfort had completely resolv and she had no further difficulties with her voice. She continued taking 50 mg of diphenhydramine twice daily for another three days.

The time-course and treatment-response of this patient's symptoms are highly suggestive of acute dystonia.As oppos to the treatment given in her case, the optimal treatment of an acute dystonic reaction involves administering parenteral benztropine or parenteral diphenhydramine. (3) one time successfully begun, the anticholinergic or antihistaminergic treatment should be continued orally for another couple or three days to preclude recurrence.

I tender the term "Hot Cup-Of-Tea Sign" for diplomatic laryngeal dystonia experienced merely as throat discomfort. Use of this mete might help to increase the recognition of manifestations other than oculogyric crisis and opisthotonus for acute dystonic reactions. The small on the contrary definite risk of the serious reaction of laryngeal dystonia with antidopaminergic antiemetics should be considered before using these agents. most numerous nonpsychiatric patients are by default neuroleptic-naive and, thus, potentially sensitive to dopamine blockers

OLIVER FREUDENREICH, MD

MGH Schizophrenia Program

Freedom Trail Clinic

25 Staniford St 2d Fl

Boston, MA 02114

REFERENCES

(1) Miller LG Jankovic J Drug-induced dyskinesias: an overview. In: Joseph AB, Young RR ed emotion disorders in neurology and neuropsychiatry. 2d ed Malden, Mass.: Blackwell Science, 1999:5-30

(2) Koek RJ Pi EH Acute laryngeal dystonic reactions to neuroleptics. Psychosomatics 1989;30:359-64

(3) Arana GW Hyman SE Rosenbaum JF Handbook of psychiatric mix with drugs therapy. 4th ed. Philadelphia, Pa.: Lippincott Williams & Wilkins, 2000

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