Make small reductions in the dose of neuroleptic until the patient no longer has marked parkinsonian symptoms. If the patient improves, it suggests that the patient was above the "therapeutic window" or at a dose where toxicity was interfering with the therapeutic outcome. Clozapine will be worth careful consideration: cases of high parkinsonism predict good outcome, even with low doses.¹
If rapid worsening occurs, go back to the last question and answer it affirmatively. A strategy for dealing with this withdrawal-induced exacerbation will be described.
This recommendation completes a consultation.
¹Spivak B, Mester R, Abesgaus J, et al. Clozapine treatment for neuroleptic-induced tardive dyskinesia, parkinsonism, and chronic akathisia in schizophrenic patients. J Clin Psychiatry 1997;58:318-322.
Recommendation #134-2
