Complex Psychiatric Patient with New-Onset Movement Disorder

Case at a Glance

A 26-year-old female with schizophrenia and complex PTSD presenting with new-onset involuntary movements and episodes of altered consciousness while on antipsychotic therapy.

Patient's Story

The patient is a 26-year-old woman with a documented history of schizophrenia and complex post-traumatic stress disorder (CPTSD) secondary to medical trauma. She is currently recovering from microcytic anemia. The patient reports developing new symptoms over recent weeks, including involuntary twitching movements in her extremities, episodes where she 'mentally checks out,' and occasional eye rolling. She describes maintaining awareness during these episodes and being able to exert some control over the symptoms with effort. The patient reports feeling overwhelmed by her psychiatric symptoms including self-harm urges, depression, PTSD symptoms, and anxiety. She continues to experience ongoing medical trauma-related stressors at home.

Initial Assessment

Current medications include Invega Trinza 525mg injection every 10 weeks for hallucinations, pantoprazole 40mg daily for acid reflux, bupropion 300mg daily for anxiety, sertraline 200mg daily for PTSD (recently increased from 150mg), and haloperidol 25mg nightly for hallucinations. The patient consumes multiple cups of coffee daily and reports sleep difficulties including trouble falling asleep and trauma-related nightmares, though she sleeps well once asleep.

The Diagnostic Journey

The patient initially suspected psychogenic non-epileptic seizures (PNES) due to the nature of her symptoms and psychological distress. However, given her current antipsychotic regimen, particularly the combination of Invega Trinza and haloperidol, differential diagnosis must include tardive dyskinesia, acute dystonia, or other medication-induced movement disorders. The timing of symptom onset in relation to medication initiation and dosing changes requires careful evaluation.

Final Diagnosis

Suspected medication-induced movement disorder, likely tardive dyskinesia, in the setting of complex psychiatric comorbidities. Rule out psychogenic non-epileptic seizures and acute stress reaction.

Treatment Plan

Immediate psychiatric consultation for medication review and movement disorder evaluation. Consider neurological consultation if movement disorder is confirmed. Adjustment of antipsychotic regimen may be necessary. Continued trauma-informed psychiatric care with emphasis on coping strategies and stress management. Sleep hygiene counseling and caffeine reduction recommendations.

Outcome and Follow-up

Patient was advised to contact her psychiatrist immediately regarding the new movement symptoms. Close monitoring of neurological symptoms and psychiatric stability required during any medication adjustments. Regular follow-up appointments scheduled to assess treatment response and symptom progression.