[Severe late-onset dystonia while on fluspirilene].

Shooting, tonic cramps of the neck muscles with jolt-like contractions in the mouth and jaw regions and propulsive movements of both arms developed in a 25-year-old woman who, over a period of six months, had been given nine intramuscular injections of the depot neuroleptic fluspirilene, 1.5 mg each, because of apathy and depression. Treatment with biperiden (up to 20 mg daily) and benzodiazepines was unsuccessful, while tiapride (up to 1000 mg daily) brought about slight improvement and 15 mg haloperidol achieved complete remission. However, distinct parkinsonian features developed. Slow gradual reduction of the haloperidol dose again led to extrapyramidal motor symptoms, even when tiapride or bromocriptine was given as well. After six months' administration of clozapine, up to 500 mg daily, and gradual dose reduction all symptoms fully regressed. This case demonstrates that the risk of extrapyramidal motor abnormalities from "neuroleptic anxiolysis" should not be underestimated.