Oculogyric Crisis — MRCPsych Paper B MCQ

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EasySchizophrenia & PsychosisOculogyric CrisisMRCPsych Paper B

A 33-year-old man with schizophrenia has taken haloperidol 10 mg daily for 3 weeks. He develops an acute, sustained conjugate upward deviation of both eyes and is markedly distressed. He remains alert and is afebrile, without generalised rigidity. What is the most likely diagnosis and immediate treatment?

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Correct answer: C — Oculogyric crisis; give benztropine 1–2 mg IM

The sustained upward eye deviation shortly after starting a potent dopamine antagonist is an oculogyric crisis, a form of acute dystonia. It requires prompt parenteral anticholinergic treatment; following discontinuation of procyclidine injection in the UK, benztropine 1–2 mg IM is the current injectable alternative. Further antipsychotic doses should be withheld pending clinical review. Tardive dyskinesia usually follows longer exposure and causes choreoathetoid, especially orofacial, movements. Akathisia causes subjective and observable restlessness rather than fixed eye deviation. Neuroleptic malignant syndrome would usually include hyperthermia, generalised rigidity, autonomic instability and altered consciousness. Preserved awareness and sustained conjugate eye deviation make an epileptic seizure less likely.

Reference: NHS Specialist Pharmacy Service. Benztropine injection for acute dystonic reactions. Updated 20 May 2026. https://sps.nhs.uk/articles/benztropine-injection-for-acute-dystonic-reactions/