Medication-Induced Movement Disorders (MIMDs)

Legislation

Chapter 616 of the 2024 Laws of New York, as amended by Chapter 37 of the 2025 Laws of New York requires the NYS Department of Health (DOH) to develop and disseminate information regarding drug-induced movement disorders as part of a health care and wellness education and outreach program. Information for health care providers shall be developed in consultation with the Office of Mental Health (OMH).

This guidance document serves as a resource for both patients and providers on drug-induced movement disorders in accordance with the above law.

Background

Drug-induced or medication-induced movement disorders (MIMDs) are a common and potentially serious adverse reaction to many medications, including medications for epilepsy, nausea or other gastrointestinal issues, psychiatric disorders, and other conditions (PMDS International Parkinson and Movement Disorder Society 2024).

This guidance focuses on movement-related adverse reactions, also known as extrapyramidal reactions, associated with antipsychotic medications and other dopamine receptor blocking agents. Antipsychotic medications are mostly associated with schizophrenia-spectrum and other psychotic disorders, but some also have FDA indications for other conditions, such as bipolar disorder, adjunctive treatment in major depressive disorder, and autism spectrum disorder. Clinicians also use antipsychotic medications off-label for other indications, including adjunctive treatment for mood and anxiety disorders, agitation in major neurocognitive disorders and delirium, severe and acute aggression or irritability in youth, and other conditions. Sometimes there may be overuse or inappropriate use of antipsychotic medications, particularly when used off-label.

The risk for movement disorders among individuals with schizophrenia spectrum disorders is of particular concern because these conditions may involve extended exposure to antipsychotic medications with a cumulative risk of adverse reactions. Providers who care for these individuals must navigate a complex risk-benefit assessment of clinical stability and the risk of movement, metabolic, and other adverse reactions that can potentially be very serious (Tiihonen 2025).

Overview

Medication-induced movement disorders can range from mild tremors to life-threatening emergencies. They can be acute (starting minutes to days after initiation of the medication), subacute (starting days to weeks after initiation), and tardive (starting weeks or more after initiation) (Rissardo 2023). Tardive disorders often persist, and may even worsen, after discontinuation of the medication (APA 2022). Table 1 provides an overview of terms associated with medication-induced movement disorders.

Table 1: Definitions of Terms Related to Medication-Induced Movement Disorders (MIMDs)

Akathisia	Subjective feeling of inner restlessness and agitation, producing an inability to sit still or remain in one place or position.
Chorea	Movement disorder characterized by involuntary, irregular, non-rhythmic, rapid, unsustained movements that flow from one body part to another and can appear fidgety or clumsy.
Dystonia	Movement disorder characterized by sustained or intermittent muscle contractions or spasms, often causing twisting, repetitive movements, or abnormal sustained postures.
Extra-pyramidal reaction	Umbrella term for movement-related adverse reactions of antipsychotic medications. It can include dystonia, akathisia, tremors, parkinsonism, and others.
Neuroleptic Malignant Syndrome (NMS)	Life-threatening complication of treatment with antipsychotic medications that is characterized by fever, severe muscle rigidity, and autonomic and mental status changes.
Parkinsonism	Extra-pyramidal side effect characterized by muscle rigidity, lack or slowing of movement (akinesia/bradykinesia), and tremor at rest.
Schizophrenia Spectrum and Other Psychotic Disorders (SSOPDs)	Family of disorders described in a chapter of the DSM5-TR with the same name. These include Schizophrenia, Schizotypal Personality Disorder, Delusional Disorder, Brief Psychotic Disorder, Schizophreniform Disorder, Schizoaffective Disorder, Substance/Medication-Induced Psychotic Disorder, Psychotic Disorder due to Another Medical Condition, Other Specified SSOPDs, and Unspecified SSOPDs.
Tardive movement disorders (or tardive syndrome)	Disorders with delayed onset and/or slow evolution that are characterized by abnormal movements likely caused by medications that block dopamine receptors in the brain. These disorders include tardive akathisia, tardive dyskinesia, tardive dystonia, and other stereotypies (repetitive movements) that may be caused by antipsychotic medications or some antiemetic medications.
Tardive dyskinesia	Late-developing and/or slow-evolving movement disorder associated with use of antipsychotic medications characterized by a wide variety of involuntary repetitive movements, including abnormal oral-lingual-facial and choreoathetoid movements, dystonia, myoclonus, and tremors.
Tremor	Involuntary, rhythmic, oscillatory shaking movement of a body part (such as in the hands). A resting tremor occurs when the body part is at rest. An action tremor occurs when the body part is being used with voluntary muscle contractions.

For more information, see:

References