A Case Report on Multiple Episodes of Deliberate Self-harm in a Patient with Amisulpride-associated Akathisia and Tardive Dyskinesia

Tardive dyskinesia is a movement disorder that causes involuntary, repetitive body movements and is commonly seen in patients who are on long-term treatment with antipsychotic medications.It occurs in 20-50% of patients taking APDs.Akathisia is a neuropsychiatric syndrome characterized by subjective and objective psychomotor restlessness whose severity can extend to self-harm and suicide.Case description: Our index case, a 57 years old, Hindu married female, of lower socio-economic status, diagnosed as a case of schizophrenia for 2 years, and well maintained on Tab.Amisulpride 600 mg daily, came in July 2022, with complaints of pain and upper abdominal discomfort and distension of abdomen for which she was prescribed Levosulpiride 50 mg daily.On next visit, in October 2022, she was having dyskinetic movements of the lips and rhythmic protrusion of the tongue, along with rhythmic movement of the whole abdomen.Eventually, she was diagnosed as a case of Levosulpiride-induced Tardive Dyskinesia and Levosulpiride was stopped.Tetrabenazine 50 mg daily was started.Subsequently, she became very restless and complained of uneasiness of whole body.Due to severe uneasiness and restlessness, she attempted suicide three times in presence of her family members and thus was prevented.In March 2023, she was having dyskinetic movement of oral cavity and rhythmic involuntary movement of the abdomen and was restless and irritable.She was continuing Amisulpride 600 mg and Tetrabenazine 50 mg daily.But unfortunately, there was no symptomatic improvement.NARANJO assessment score was applied which showed probable drug reaction.Then, it was diagnosed as a case of Amisulpride-induced Tardive Dyskinesia with Akathisia.Amisulpride was also stopped and no antipsychotics were given.For Akathisia, Lorazepam 4 mg in divided doses and Propranolol 40 mg was added to Tetrabenazine 75 mg daily.Now, patient started improving, having no fresh complaints although presently not on antipsychotics.