benztropine and Bipolar-Disorder

Topics: Adolescent; Antiparkinson Agents; Antipsychotic Agents; Aripiprazole; Benztropine; Bipolar Disorder; Dystonia; Humans; Lithium; Male; Marijuana Abuse; Quetiapine Fumarate; Risk-Taking

Ischemic colitis is a rare adverse effect of antipsychotic medications and is most commonly associated with the phenothiazine class of antipsychotics and atypical antipsychotics such as clozapine and olanzapine. The risk is further increased when antipsychotics are taken in conjunction with anticholinergics. A 27-year-old man with a history of bipolar disorder and depression presented to the emergency department with 6 days of constipation, abdominal pain, nausea, and nonbloody vomiting. He later developed multiple episodes of hematochezia and fever. Within the preceding 2 weeks, his medication regimen of divalproex sodium, aripiprazole, and trihexyphenidyl, had been changed to olanzapine, benztropine, and bupropion. The patient's physical examination showed diffuse abdominal tenderness, guarding, and distension and laboratory tests revealed a leukocytosis. A computed tomographic scan of the abdomen/pelvis showed colitis extending from the splenic flexure to the sigmoid colon, without evidence of perforation. A colonoscopy revealed severe ischemic colitis involving the descending and sigmoid colon, which was confirmed on biopsy. Given the temporal association between the new medications and onset of symptoms, the patient's ischemic colitis was likely caused by olanzapine or the combination of olanzapine and benztropine, likely secondary to their anticholinergic properties. Thus, providers should take a thorough history and counsel patients regarding the risks of constipation when starting antipsychotic medications, particularly those with anticholinergic activity. Despite the fact that ischemic colitis is such a rare adverse effect of antipsychotic medications, it is important to consider because of its potentially fatal outcomes.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Benztropine; Bipolar Disorder; Colitis, Ischemic; Drug Therapy, Combination; Humans; Male; Muscarinic Antagonists; Olanzapine; Tomography, X-Ray Computed

A 55-year-old female with a diagnosis of schizophrenia currently resides in an assisted living facility in a large metropolitan suburb. For approximately 25 years, the patient was relegated to a life of poor symptom control and social adjustment, largely due to nonadherence, relapse, and rehospitalization. The patient experienced a trial-and-error approach to drug therapy, which resulted in reliance on the older or first generation agents for symptom improvement. This case supports the assertion that the second-generation or atypical antipsychotics used to treat schizophrenia are no better than older drugs in terms of efficacy or tolerability.

Topics: Antipsychotic Agents; Benztropine; Bipolar Disorder; Borderline Personality Disorder; Drug Substitution; Drug Therapy, Combination; Female; Humans; Longitudinal Studies; Middle Aged; Psychotic Disorders; Retrospective Studies; Schizophrenia; Schizophrenic Psychology; Social Adjustment; Thiothixene; Treatment Outcome; Weight Gain

Topics: Adolescent; Antimanic Agents; Antipsychotic Agents; Benztropine; Biotransformation; Bipolar Disorder; Carbamazepine; Dose-Response Relationship, Drug; Drug Interactions; Drug Therapy, Combination; Female; Fluoxetine; Humans; Lithium Carbonate; Metabolic Clearance Rate; Ranitidine; Risperidone; Stupor; Valproic Acid

Extrapyramidal symptoms (EPSs) (dystonic reaction, rigidity, and akathisia) occur as a result of D2 receptor blockade. Selective serotonin-reuptake inhibitors (SSRIs) have been reported to induce extrapyramidal signs and symptoms but tricyclic antidepressants have been rarely reported. Among the side effects attributed to valproic acid administration, the production of EPS is very rare, particularly in children. In this paper we present a case (10-year-old girl) under multiple pharmacologic treatment who developed EPSs (oculogyric crisis) shortly after the adjunct of imipramine to a combination of methylphenidate and valproic acid. Oculogyric crisis occurred on the third day of this combination treatment and these symptoms included ocular pain and sustained upward gaze. Benztropine 2 mg i.m. resulted in rapid relief of oculogyric crisis symptoms.

Topics: Attention Deficit Disorder with Hyperactivity; Benztropine; Bipolar Disorder; Child; Comorbidity; Dose-Response Relationship, Drug; Drug Interactions; Drug Therapy, Combination; Dyskinesia, Drug-Induced; Female; Humans; Imipramine; Injections, Intramuscular; Methylphenidate; Neurologic Examination; Ocular Motility Disorders; Psychotropic Drugs; Valproic Acid

Topics: Benztropine; Bipolar Disorder; Cytochrome P-450 CYP2D6 Inhibitors; Drug Interactions; Drug Therapy, Combination; Female; Humans; Lithium Compounds; Middle Aged; Neuroleptic Malignant Syndrome; Paroxetine; Perphenazine; Psychotropic Drugs; Trazodone

A patient with a treatment-refractory bipolar disorder with ultradian cycling responded to adjunctive topiramate. Response was maintained during 3-year follow-up.

Topics: Activity Cycles; Adult; Anticonvulsants; Antimanic Agents; Antipsychotic Agents; Benztropine; Bipolar Disorder; Drug Resistance; Drug Therapy, Combination; Follow-Up Studies; Fructose; Humans; Lithium Compounds; Loxapine; Parasympatholytics; Topiramate; Valproic Acid

Topics: Adult; Antipsychotic Agents; Behavior; Benzodiazepines; Benztropine; Bipolar Disorder; Drug Interactions; Humans; Male; Muscarinic Antagonists; Olanzapine; Pirenzepine; Risperidone

Topics: Akathisia, Drug-Induced; Benztropine; Bipolar Disorder; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Lithium Carbonate; Middle Aged; Neuroleptic Malignant Syndrome; Neurologic Examination; Paroxetine; Perphenazine; Receptors, Serotonin; Trazodone

Topics: Antiparkinson Agents; Benztropine; Bipolar Disorder; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Overdose; Humans; Infusions, Intravenous; Male; Middle Aged; Parasympathomimetics; Physostigmine; Veterans

Identification of symptoms that are directly responsive to neuroleptic drugs at progressive phases of treatment is important for monitoring drug response and understanding the relationship between neurochemical mechanisms of drug action and disordered behavior. Using multiple regression analyses that controlled for pretreatment severity, we identified those symptoms that improved in direct relation to serum concentrations of perphenazine after 10 days of treatment. Improvement in two positive symptoms of psychosis--hallucinations and conceptual disorganization--appears to be related to perphenazine level and useful for assessment of early drug response.

Topics: Adult; Benztropine; Bipolar Disorder; Depressive Disorder; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Haloperidol; Humans; Male; Perphenazine; Psychiatric Status Rating Scales; Psychotic Disorders; Schizophrenia; Schizophrenic Psychology

Topics: Adult; Benztropine; Bipolar Disorder; Coma; Diagnosis, Differential; Drug Therapy, Combination; Haloperidol; Humans; Lithium; Male; Neuroleptic Malignant Syndrome

Acute anticholinergic delirium has been reported to occur following ingestion of antidepressants, neuroleptics and antiparkinsonian drugs in toxic and therapeutic doses. A case is described of a chronic central anticholinergic syndrome in a patient receiving a combination of such drugs. This chronic anticholinergic toxicity was superimposed on manic depressive illness which resulted in incorrect diagnoses including schizophrenia and dementia and, accordingly, improper management. Diagnosis of central anticholinergic toxicity may be overlooked in psychiatric patients because the symptoms of toxicity can be incorrectly ascribed to psychiatric illness. It may also be overlooked in elderly patients who are prone to demonstrate confusion and problems with memory. The recognition of this syndrome in the patient reported, at least nine years after it developed, led to appropriate management which ultimately resulted in a dramatic change in her ability to function.

Topics: Aged; Amitriptyline; Benztropine; Bipolar Disorder; Central Nervous System Diseases; Dementia; Diagnostic Errors; Female; Humans; Imipramine; Thioridazine; Tropanes

The authors describe a fatal episode of intestinal dilatation associated with chlorpromazine therapy. A total of 26 similar cases associated with phenothiazine or tricyclic antidepressant therapy, including 9 fatalities, has been reported in the literature. The authors cite experimental evidence supporting this association. They emphasize the difficulty of recognizing this syndrome in the psychotic patient; careful evaluation is indicated in the constipated patient who exhibits vomiting, abdominal pain, distension, or tenderness.

Topics: Adult; Benztropine; Bipolar Disorder; Chlorpromazine; Dilatation, Pathologic; Drug Therapy, Combination; Gastrointestinal Motility; Humans; Intestinal Diseases; Intestines; Lithium; Male

A distinctive pattern of clinical change during eight affective episodes is reported in a rapidly cycling manic-depressive patient. After a rapid switch to near maximal intensity of affective symptoms, slow changes in symptomatology were documented by significant slopes and correlation coefficients over the course of each episode. Decreases in depression, anxiety, drowsiness, helplessness/hopelessness, anger, and sadness preceded the switches into mania; decreases in mania, euphoria, seeking others, and talking preceded the switches into depression. Psychologically important events appeared to regularly precede rapid mood switches. It is suggested that the consistent, slow clinical changes which occur during affective episodes may reflect part of an underlying rhthmic biological process and that environment events may be capable of triggering a final common pathway for the mood switch during a vulnerable period.

Topics: Adult; Benztropine; Bipolar Disorder; Female; Humans; Lithium; Motor Activity; Periodicity; Stress, Psychological

Neurological examinations of 27 outpatients receiving lithium carbonate maintenance therapy for recurrent affective illness revealed that most of the patients receiving lithium for more than 8 months had cogwheel rigidity. The data suggest a positive correlation between the duration of lithium maintenance and the severity of cogwheeling. Intravenous administration of benztropine, an antiparkinsonian drug, did not abolish or significantly ameliorate this symptom.

Topics: Adult; Affective Symptoms; Aged; Basal Ganglia Diseases; Benztropine; Bipolar Disorder; Carbonates; Female; Humans; Injections, Intravenous; Lithium; Long-Term Care; Male; Middle Aged; Time Factors

Topics: Adjustment Disorders; Aged; Alzheimer Disease; Amitriptyline; Benztropine; Bipolar Disorder; Catatonia; Chlorpromazine; Dementia; Female; Humans; Lithium; Male; Mental Disorders; Psychopharmacology; Psychoses, Substance-Induced; Thioridazine; Tranquilizing Agents; Trifluoperazine

Topics: Benztropine; Bipolar Disorder; Electroconvulsive Therapy; Female; Humans; Lithium; Middle Aged; Nortriptyline; Phenelzine; Psychological Tests; Thioridazine; Time Factors