A 22-year-old man started on haloperidol for acute psychosis returns the next morning with torticollis, trismus, and inability to speak. He is afebrile with normal vital signs. The most appropriate immediate treatment is:

• A Intravenous benztropine ✓
• B An increased dose of haloperidol
• C Intravenous propranolol
• D Oral bromocriptine

Explanation

This is an acute dystonic reaction, the earliest extrapyramidal syndrome, common with high-potency typical agents like haloperidol in young males. It results from striatal dopamine blockade and responds dramatically to parenteral anticholinergics such as benztropine or promethazine within minutes. Propranolol treats akathisia, bromocriptine is used in neuroleptic malignant syndrome, and increasing haloperidol would worsen the reaction.

Reference: Katzung's Basic and Clinical Pharmacology, 15th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.