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NANCY C. BRAHM, PHARM.D., M.S., BCPP, is Clinical Associate Professor, Department of Pharmacy: Clinical and Administrative Sciences, College of Pharmacy, University of Oklahoma (UO), Tulsa. DAVID L. MCELWAIN, M.D., Private Practice of Outpatient Psychiatry, Tulsa, OK. ROBERT C. BROWN, M.D., is Adjunct Clinical Associate Professor, College of Pharmacy, UO, and Medical Director, Oklahoma Department of Human Services/Developmental Disabilities Services Division, Oklahoma City.

Address correspondence to Dr. Brahm at the College of Pharmacy, University of Oklahoma, 4502 East 41st Street, 2H17, Tulsa, OK 74135-2512 (nancy-brahm{at}ouhsc.edu).

Purpose. A case of extrapyramidal symptoms (EPS) following administration of aripiprazole to a man with developmental disabilities who had never received antipsychotic medications and had no history of movement disorders is presented. Summary. The patient was a 40-year-old male with developmental disabilities. He was nonverbal, profoundly mentally retarded, and diagnosed with obsessive compulsive disorder (OCD) and orthopedic problems. He developed episodic movements possibly consistent with EPS secondary to aripiprazole usage. The patient was antipsychotic naive before initiation of aripiprazole 5 mg daily. Concurrent medications at the time of EPS onset included oxazepam, baclofen, and citalopram. Baclofen and oxazepam were prescribed secondary to right-sided hemiparesis contractures. Aripiprazole, 5 mg daily, was initiated in November 2004 as an augmentation strategy for the diagnosis of OCD. Facial, tongue, and arm movements were first reported approximately five weeks after the initiation of aripiprazole. Initial symptoms resolved after approximately 24 hours. The dosage was increased to 10 mg daily two weeks later. Dystonic episodes continued on an intermittent basis, and the patient presented with lower-lip thrusting and upper-limb athetosis. These movements interfered with the patient’s eating, chewing, and holding of utensils. Several of the standard treatment strategies for EPS were used. Initially, diphenhydramine hydrochloride 25 mg was administered orally every six hours. The patient’s movements resolved following diphenhydramine administration. Aripiprazole was subsequently discontinued secondary to its lack of efficacy for OCD and the development of a movement disorder. Conclusion. A patient with developmental disabilities who had no history of movement disorders developed EPS following initiation of aripiprazole. Index terms: Antipsychotic agents; Aripiprazole; Baclofen; Basal ganglia diseases; Citalopram; Diphenhydramine hydrochloride; Dosage; Oxazepam; Toxicity