benztropine and Catatonia

Patients who present with acute neuropsychiatric syndromes pose difficult diagnostic and treatment challenges. A history of psychiatric illness and treatment with psychotropic medication may be valuable clues to diagnosis and management of such patients. However, this information may also tempt a clinician to focus on a premature diagnosis, excluding other important possibilities. A case of a 42-year-old male with recurrent psychotic illness who developed an abrupt deterioration in mental and physical status is presented. Despite an initial good response to physostigmine, he was diagnosed with neuroleptic malignant syndrome and did not receive subsequent treatment with cholinesterase inhibitors. The patient expired within hours of arriving in the emergency room. The postmortem benztropine level was elevated, leading to the attribution of death to anticholinergic toxicity. This case serves to illustrate the difficulties in distinguishing features of anticholinergic toxicity and neuroleptic malignant syndrome.

Topics: Adult; Antipsychotic Agents; Benztropine; Catatonia; Cholinergic Antagonists; Diagnosis, Differential; Dose-Response Relationship, Drug; Drug Therapy, Combination; Fatal Outcome; Humans; Male; Neuroleptic Malignant Syndrome; Psychotic Disorders

The neuroleptic malignant syndrome (NMS) is a rare but potentially lethal disorder associated with the administration of neuroleptic agents. This syndrome may be underdiagnosed because it is poorly understood and often unrecognized. It affects all age groups and has a 20% mortality. Presenting features include extrapyramidal symptoms, altered mental consciousness, autonomic dysfunction, and hyperthermia. The underlying explanation for these manifestations is a disturbance of the dopaminergic system within the basal ganglia and hypothalamus. Dantrolene (Dantrium), amantadine (Symmetrel), and bromocriptine mesylate (Parlodel) have been efficacious in conjunction with supportive therapy. I report three cases successfully treated with bromocriptine and supportive therapy.

Topics: Adolescent; Adult; Benztropine; Bromocriptine; Catatonia; Child; Child, Preschool; Diagnosis, Differential; Female; Fluphenazine; Haloperidol; Heat Exhaustion; Humans; Male; Malignant Hyperthermia; Middle Aged; Neuroleptic Malignant Syndrome; Psychotic Disorders; Schizophrenia, Paranoid; Time Factors

Topics: Adult; Benztropine; Catatonia; Humans; Male; Schizophrenia; Substance-Related Disorders

Topics: Anti-Anxiety Agents; Arousal; Benzodiazepines; Benztropine; Catatonia; Female; Humans; Middle Aged; Tropanes

The importance of considering organic diseases when evaluating catatonic patients is illustrated by two cases of akinetic parkinsonism in which the patients became catatonic, with waxy flexibility. The catatonic syndrome occurs in association with a variety of lesions that may affect any level of the central nervous system from the brain stem to the cerebral hemispheres. A review of Parkinson's disease and a critical reappraisal of the catatonic syndrome are presented.

Topics: Adult; Akinetic Mutism; Benztropine; Carbidopa; Catatonia; Humans; Levodopa; Male; Parasympatholytics; Parkinson Disease; Syndrome

A case is reported in which catatonia and autonomic abnormalities occurred in a patient on long-term fluphenazine decanoate following overdose with an oral anorectic agent containing phenylpropanolamine and caffeine. The catatonic symptoms showed a rapid and complete resolution following intramuscular benztropine. A possible mechanism to explain the catatonic symptoms is discussed.

Topics: Benztropine; Caffeine; Catatonia; Fluphenazine; Humans; Male; Middle Aged; Phenylpropanolamine; Receptors, Dopamine

An unusual, acute extrapyramidal reaction, which resulted from treatment with haloperidol and which was unresponsive to standard anticholinergic treatment and indistinguishable on clinical grounds from acute catatonia, is described. Because the etiology of this reaction was not appreciated, progressive, life-threatening physiological deterioration ensued accompanied by unremitting neuromuscular symptoms, a clinical picture resembling both "lethal catatonia" and the rare "neuroleptic malignant syndrome." The literature on these conditions is reviewed and various problems in differential diagnosis are discussed. It is proposed that some cases of the neuroleptic malignant syndrome and perhaps lethal catatonia may represent the evolution of severe extrapyramidal reactions.

Topics: Adult; Basal Ganglia Diseases; Benztropine; Catatonia; Diagnosis, Differential; Haloperidol; Humans; Male; Syndrome

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: Adult; Basal Ganglia Diseases; Benztropine; Catatonia; Coma; Creatine Kinase; Female; Fever; Fluphenazine; Humans; Movement Disorders; Muscle Rigidity; Phenothiazines; Schizophrenia; Syndrome