Abnormal Movements Resembling Tic Disorder in a Patient with Schizophrenia: A Case Report

Abstract

Introduction: Since many movement disorders are associated with schizophrenia, it is important to distinguish various motor manifestations of the disease itself from associated abnormal movements. Case Presentation: We present a 35-year-old single man with schizophrenia who was admitted for seizure-like tics. The disease started 7 years earlier with psychotic manifestations, including persecutory delusion, negative symptoms, and impaired function. About a year ago, movements in the limbs, abdomen, and spine (similar to those seen in tonic-clonic seizures) were added to the patient’s symptoms, lasting for a few seconds to a few minutes. After some time, these movements were accompanied by expressing words and phrases that had sexual content. Due to the exacerbation of these attacks, the patient was admitted to the hospital. He was unable to explain the cause of these movements, and differential diagnoses included stereotype, extrapyramidal effects of antipsychotic drugs (particularly tardive dyskinesia), and temporal lobe epilepsy. However, the patient had no history of epilepsy. Urine screening for illegal substances, electroencephalography (EEG), brain magnetic resonance imaging (MRI), and neurological counseling were all normal. The adverse effects of medications were ruled out because the patient had taken antipsychotics very irregularly and in low doses. A short time after starting 4 mg of oral risperidone (as the main treatment), the patient showed better cooperation and was able to describe his symptoms in more detail. He explained that a stranger or a copy of himself occasionally compelled him to do the movements, and if he refused to do it, he would be punished by them. Ten days after continuing treatment and starting weekly flupentixol decanoate, the motor symptoms improved significantly, and the patient was discharged after 3 weeks. Conclusions: This case presentation emphasizes the importance of accurate clarification of the nature of signs and symptoms in patients with mental disorders, which seems to be crucial in making a diagnosis and appropriate treatment.