Paroxysmal Dystonia and Psychotic Exacerbations in chronic psychosis - Diagnostic dilemmas and preliminary treatment approaches.

Patients with chronic psychosis on prolonged antipsychotic therapy may present with paroxysmal dystonia along with an exacerbation of their psychotic symptoms - Paroxysmal Dystonia and Psychotic Exacerbations (PDPE). The inter-individual variability in the clinical presentations of PDPE can pose challenges in its diagnosis and treatment. The objectives of this work are to a) discuss this rare phenomenon through a series of ten patients and a relevant literature review, b) conceptualise its neurobiological underpinnings, and c) explore the preliminary treatment approaches for its management. Acute stress and/or a dysfunctional GABAergic or dopaminergic system may be implicated in the pathogenesis of PDPE. The episodes respond acutely to parenteral benzodiazepines, while long-term management can be achieved by reducing antipsychotic doses, switching to clozapine or using central GABA-enhancers. This article is the first attempt at conceptualising and exploring treatment options for the rare condition, PDPE and intends to guide future research in this regard.