For a patient with involuntary facial movements on risperidone, what is the best therapeutic change?

In the context of a patient exhibiting involuntary facial movements while on risperidone, the most appropriate therapeutic change involves discontinuing the risperidone and considering a referral for psychotherapy.

Involuntary facial movements can be indicative of tardive dyskinesia, a potential side effect associated with the use of antipsychotic medications like risperidone. When such movements occur, the precedence in treatment typically requires addressing the offending medication directly rather than making adjustments or adding medications that could exacerbate the situation. Discontinuing risperidone comes first, as it could help mitigate the side effects experienced by the patient.

Psychotherapy can provide support to help the patient manage any psychological distress associated with the involuntary movements and the potential stigma or emotional consequences of such side effects. It also may allow exploration of coping strategies, which could be beneficial as the medications are being adjusted.

Other therapeutic changes would not effectively address the underlying issue of involuntary movements linked to risperidone. For example, simply decreasing the dose and adding clonazepam would not eliminate the risk of continuing exposure to the side effects of risperidone. Replacing it with clozapine or fluoxetine may not directly address the issue of tardive