Skill Checkup: A 55-Year-Old Man With Schizophrenia and New-Onset Involuntary Movements

Christoph U. Correll, MD


August 08, 2023

The Skills Checkup series provides a quick, case-style interactive quiz, highlighting key guideline- and evidence-based information to inform clinical practice.


A 55-year-old man in the United States presented with new-onset repetitive mouth movements, which resemble chewing. He lives with his sister, who first noticed these movements approximately 1 month ago. When questioned, the patient did not recall experiencing any unusual mouth movements. He has a history of schizophrenia, which was diagnosed when he underwent a psychiatric hospitalization owing to auditory and visual hallucinations at 22 years of age. Since then, his hallucinations have generally been managed on antipsychotic medication. He was initially treated with a typical (first-generation) antipsychotic, with his current psychiatrist switching him to an atypical (second-generation) antipsychotic approximately 10 years ago. There have been no changes to his antipsychotic medication regimen (type or dose) in the past year. Upon physical examination, the patient exhibited involuntary, repetitive, and stereotyped puckering and smacking of his lips. Upon close examination, repetitive movement of his fingers was observed when he was asked to walk with his arms resting at his sides. His total dyskinesia score on the Abnormal Involuntary Movement Scale (AIMS) was 8, with a global rating of 3. No rigidity was observed (which has been well controlled with an antihypertensive agent for the past 8 years) and gastroesophageal reflux disorder (which has been treated with a proton pump inhibitor for the past 2 years).


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