Neuroleptic-induced respiratory dyskinesia

Respiratory dyskinesia is a common but under-recognized side effect of chronic neuroleptic administration. It manifests as irregular respiration, dyspnea, grunting or gasping, and abnormal chest or esophageal movements. It occurs almost exclusively in association with other tardive effects of neuroleptics, such as tardive dyskinesia and tardive akathisia. Complications of the disorder include respiratory alkalosis and aspiration pneumonia. The authors describe 5 patients with respiratory dyskinesia whose cases highlight the important clinical features of neuroleptic-induced respiratory dyskinesia and the manner in which some cases may be misdiagnosed. They also review the literature on this syndrome and discuss the likely pathophysiological mechanisms.