benztropine and Acute-Disease

We challenged six patients suffering from acute neuroleptic-induced akathisia (NIA) with intravenous benztropine (2 mg), propranolol (1 mg), and placebo (saline) using a random, double-blind cross-over design to examine the effects of the drugs on the subjective, objective, and global manifestations of NIA. Benztropine produced a significant amelioration of NIA, more apparent in its subjective component. Propranolol failed to produce a significant improvement overall in any of the akathisia measures, with only one patient showing clinical improvement. The patients demonstrated considerable placebo effect and marked variation in their responses to the drugs.

Topics: Acute Disease; Adult; Akathisia, Drug-Induced; Antipsychotic Agents; Benztropine; Double-Blind Method; Female; Humans; Injections, Intravenous; Male; Middle Aged; Placebos; Propranolol

The authors performed a prospective double-blind study of 39 inpatients beginning high-potency neuroleptics. Patients were randomly assigned to a 7-day course of benztropine or placebo in addition to a neuroleptic. Of 17 patients receiving placebo, eight (47%) suffered an acute dystonic reaction; of 22 patients receiving benztropine, none suffered this reaction--a highly significant difference. The authors also found minimal anticholinergic toxicity attributable to the addition of benztropine to the neuroleptic regimen. These results suggest that an initial 7-day prophylaxis with benztropine is a high-benefit, low-risk adjunctive treatment to neuroleptic therapy.

Topics: Acute Disease; Adolescent; Adult; Antipsychotic Agents; Benztropine; Double-Blind Method; Drug Therapy, Combination; Dystonia; Female; Humans; Male; Prospective Studies; Random Allocation; Tropanes

This rater blind project compared the efficacy and safety of using an oral rapid or neuroleptization method (maximum 80 mg./day) versus fixed standard dosage (20 mg./day) fluphenazine, a commonly used neuroleptic. There were 32 hospitalized, acutely decompensated schizophrenic patients in the experiment; the study period for each patient was a maximum of 7 days. The data were collected using the Benjamin Proverb Test and rating scales for psychopathology and adverse effects. Data analysis by means of the analysis of covariance demonstrated few significant differences between the 2 treatment methods: both methods produced a similar reduction in psychopathological symptoms and incidence of adverse effects. The authors conclude that the rapid neuroleptization method is not superior to the fixed standard dosage method in treating acute schizophrenia.

Topics: Acute Disease; Adult; Benztropine; Clinical Trials as Topic; Dose-Response Relationship, Drug; Double-Blind Method; Drug Therapy, Combination; Female; Fluphenazine; Humans; Male; Middle Aged; Parkinson Disease, Secondary; Psychiatric Status Rating Scales; Psychopathology; Schizophrenia; Schizophrenia, Paranoid

Topics: Acute Disease; Adult; Antiparkinson Agents; Arousal; Benztropine; Chronic Disease; Clinical Trials as Topic; Female; Hallucinations; Haloperidol; Humans; Male; Placebos; Psychopathology; Schizophrenia; Sleep Initiation and Maintenance Disorders; Trihexyphenidyl; Tropanes

Topics: Acute Disease; Benztropine; Clinical Trials as Topic; Cognition Disorders; Dose-Response Relationship, Drug; Haloperidol; Humans; Milieu Therapy; Placebos; Psychiatric Status Rating Scales; Research Design; Schizophrenia; Schizophrenic Psychology; Sleep; Time Factors

Topics: Acute Disease; Adult; Antipsychotic Agents; Benztropine; Consciousness Disorders; Diagnosis, Differential; Female; Haloperidol; Humans; Parasympatholytics; Psychotic Disorders

A case of acute dystonia related to rivastigmine use is reported.. A 61-year-old Caucasian woman who had suffered from bipolar II disorder with rapid cycling for over 30 years was admitted to an inpatient psychiatry unit. In addition to bipolar II disorder, the patient had been previously diagnosed with early-stage Alzheimer's disease, posttraumatic stress disorder, and various anxiety disorders. During the current hospitalization, she was taking clonazepam, dextroamphetamine, lamotrigine, lansoprazole, levothyroxine, memantine, quetiapine, risperidone, rivastigmine, tranylcypromine, trazodone, and zolpidem. Soon after hospital admission, she began to complain of a tightening in her chest. A review of her records revealed similar complaints during previous hospitalizations. Rivastigmine was discontinued due to concerns of interactions with her antipsychotic regimen. Although these symptoms were previously attributed to anxiety, they appeared worse during this hospitalization. During these events she would be witnessed lying in bed in a supine position with her head canted posteriorly. Benztropine was given to help determine if she was having a dystonic reaction. Within 30 minutes, her chest discomfort began to resolve, and her symptoms resolved completely over the next 48 hours. Three days later, rivastigmine was restarted by the attending psychiatrist because of concerns about the patient's memory, and the dystonia-like symptoms returned within 2 hours of her morning dose. Rivastigmine was discontinued, and benztropine was given and then discontinued, with no return of symptoms for the remainder of her two-week hospitalization.. A patient with bipolar II disorder and mild-to-moderate Alzheimer's disease developed dystonia, possibly caused by rivastigmine. However, the patient was taking various other medications that could have lowered the threshold for extrapyramidal syndromes.

Topics: Acute Disease; Alzheimer Disease; Antipsychotic Agents; Benztropine; Cholinesterase Inhibitors; Comorbidity; Cyclothymic Disorder; Drug Interactions; Dystonia; Extrapyramidal Tracts; Female; Humans; Middle Aged; Phenylcarbamates; Rivastigmine; Syndrome

Topics: Acute Disease; Aged; Antipsychotic Agents; Benztropine; Drug Interactions; Female; Haloperidol; Humans; Intestinal Pseudo-Obstruction; Muscarinic Antagonists

Topics: Acute Disease; Adult; Benztropine; Drug Interactions; Dystonia; Female; Humans; Injections, Intramuscular; Loxapine; Migraine Disorders; Sumatriptan

Young adults treated with a high potency neuroleptic such as haloperidol are at high risk of developing dystonic reactions. In this retrospective study, 15 of 16 young adult patients treated only with haloperidol had such reactions within 60 hours of beginning the drug, while none of the seven patients treated with haloperidol plus prophylactic benztropine mesylate developed dystonia. Although methodologic considerations limit the generalization of these results, they are consistent with other reports and suggest that initial anticholinergic prophylaxis is warranted in young patients treated with high potency antipsychotics. All dystonic reactions in these patients occurred within 2 1/2 days, justifying the consideration of discontinuing prophylaxis (which also causes side effects) after 1 week.

Topics: Acute Disease; Adult; Benztropine; Drug Therapy, Combination; Dystonia; Female; Haloperidol; Humans; Male; Parasympatholytics; Psychotic Disorders; Retrospective Studies; Tropanes

We report an unusual case of benztropine-induced acute dystonia and dyskinesia without findings of acute anticholinergic toxicity in a 20-month-old child. Laboratory analysis of blood, urine, and gastric contents demonstrated the presence of an atropinic compound and diphenhydramine only, suggesting the association of benztropine and acute dystonia. Effects of benztropine on neuronal uptake of dopamine may represent a possible mechanism for this unusual adverse effect.

Topics: Accidents; Acute Disease; Benztropine; Dyskinesia, Drug-Induced; Dystonia; Emergencies; Humans; Infant; Male; Therapeutic Irrigation; Tropanes

Metoclopramide is an effective non-phenothiazine antiemetic that acts, in part, by blockade of the dopamine receptors. The extrapyramidal complications of metoclopramide are similar to those of the phenothiazines. A patient is reported who developed a metoclopramide-induced acute dystonic reaction lasting 53 days. Acute and chronic treatment with anticholinergic drugs suppressed but did not eliminate the adventitious movements. The features of acute dystonic reactions secondary to metoclopramide therapy are reviewed.

Topics: Acute Disease; Adult; Benztropine; Female; Humans; Metoclopramide; Movement Disorders; Nausea; Time Factors

Dystonic reactions to neuroleptic and antiemetic medications are commonly seen in the outpatient setting. Despite initially successful treatment in the emergency department, symptoms may later recur. We have recently seen several cases of recurrent dystonic reactions; four representative cases are reported. Three of the patients experienced no further dystonic reactions when treated appropriately as outpatients. The fourth patient was lost to follow up. Based on this experience in the pharmacology of the drugs involved in producing and treating dystonic reactions, it is recommended that patients successfully treated in the emergency department for dystonia receive continued outpatient therapy for 48 to 72 hours.

Topics: Acute Disease; Adult; Benztropine; Biperiden; Diphenhydramine; Dystonia; Female; Humans; Jaw; Male; Recurrence; Trihexyphenidyl; Trismus

Topics: Acute Disease; Basal Ganglia Diseases; Benztropine; Dyskinesia, Drug-Induced; Female; Humans; Middle Aged; Remission, Spontaneous; Tranquilizing Agents; Tropanes

We reviewed the use of physostigmine in the diagnosis and management of acute toxic psychosis due to drugs with anticholinergic properties. The syndrome of agitation and toxic confusional psychosis associated with peripheral signs of cholinergic blockade is produced by several plant toxins, antispasmodics, ophthalmic preparations, and certain proprietary sedatives, as well as antiparkinson medications, antidepressants, and some antipsychotic drugs. Physostigmine, uniquely among the available reversible anticholinesterase agents, can pass the blood-brain barrier to exert central as well as peripheral cholinomimetic actions to reverse this syndrome. Psychiatrists should make more use of this safe, specific, rapid, and effective treatment for anticholinergic drug toxicity, and should particularly be alert to reversible anticholinergic brain syndromes associated with antidepressants and antiparkinson medications, and even with antipsychotic medications.

Topics: Acute Disease; Adult; Amitriptyline; Benztropine; Chemical Phenomena; Chemistry; Cholinesterase Inhibitors; Doxepin; Female; Haloperidol; Humans; Male; Nervous System Diseases; Parasympatholytics; Physostigmine; Psychoses, Substance-Induced; Syndrome; Thioridazine