Please help me figure out what is going on with my little brother. (Movement disorder)
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My younger brother is 36M, 5'6", approximately 75 kg. He has a history of schizophrenia diagnosed almost 16 years ago.
His medication history is that he was on Invega for about 5 years and various antipsychotics before that. He was stable on Invega but totally disconnected from society and had a very difficult time being completely isolated for a number of years.
In the past year, we have been able to get him a much better level of care by moving to Pakistan, including biopsychosocial support, but this movement problem remains unaddressed.
The movements are of 3 types:
Sudden jerky movements, as seen in the video.
OCD-like movements where he air-washes his hands repetitively or touches his glasses over and over again.
Head shaking, leg tapping, and what you could maybe describe as restless movements.
In the video, you can also see that sometimes he goes into a trance-like stare where he isn't very responsive. Usually, this happens after a period of inactivity. He is aware of his surroundings, but he just seems to get stuck.
His current medications include clomipramine 25 mg, olanzapine 5 mg, and a small dose of lorazepam.
I'm concerned that this could be some kind of medication-induced movement disorder, given his long history of antipsychotic use, but I really don't know.
Could this be tardive dyskinesia, akathisia, catatonia, or something else entirely? I'm also wondering whether these are different types of movements with different causes.
Please, please reach out if you have any ideas. It's been really worrisome, and his doctor here doesn't really seem to understand what's happening.
Thank you 🙏