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Missed diagnosis of tardive dystonia in an adolescent girl treated with risperidone.

Tardive dystonia is a subtype of neuroleptic induced tardive dyskinesia characterized by sustained, slow, involuntary twisting movements affecting the limbs, trunk, neck, or face. Similar to idiopathic dystonia, symptoms can fluctuate in intensity and be relieved by certain postures or positions (a ‘‘sensory trick’’). Although these characteristics are commonly noted by clinicians well acquainted with this disorder, they may be a source of confusion to clinicians whose experience with neuroleptic induced movement disorders is limited. In the following case report, an adolescent girl with neuroleptic induced tardive dystonia misdiagnosed as conversion disorder is described. The purpose of this case report is to describe the features of tardive dystonia and its management in children to improve recognition of this disabling disorder.