benztropine and Delirium

Topics: Antidepressive Agents; Antiparkinson Agents; Atropine; Benztropine; Clinical Trials as Topic; Delirium; Drug Combinations; Humans; Memory Disorders; Parasympatholytics; Perphenazine; Placebos; Psychoses, Substance-Induced

An 11-year-old boy presented with an antimuscarinic toxidrome due to benztropine and risperidone ingestion. His delirium was prolonged and difficult to treat with benzodiazepines. Multiple doses of physostigmine successfully treated it. Benztropine is a potent antimuscarinic agent, whereas risperidone has not been reported to cause antimuscarinic toxicity. The use of physostigmine to treat benztropine intoxication in a pediatric patient has not previously been described. In this case, multiple doses were used and were well tolerated.

Topics: Benztropine; Child; Cholinesterase Inhibitors; Delirium; Humans; Male; Muscarinic Antagonists; Physostigmine

The use of lithium carbonate for the treatment of mood disorders in old age has decreased at a dramatic rate in favor of valproate. Because of lithium's narrow therapeutic range, neurotoxicity can be an important complication in lithium therapy and potentially influence prescription patterns. Therefore, we compared the incidence of delirium in older adults with mood disorders who were newly dispensed either lithium or valproate.. Using 4 population-based administrative databases from the province of Ontario, Canada (the Ontario Drug Benefit program, the Canadian Institute for Health Information, the Ontario Health Insurance Plan, and the Registered Persons Data Base), we were able to identify a cohort of mood disorder patients 66 years and older who were newly dispensed lithium or valproate over an 8-year period (1993-2001). Measures were taken to ensure that the sample was composed of mood disorder patients. As a comparator, we included a known deliriogenic drug, benztropine. The main outcome measure was a new diagnosis of delirium on a hospitalization record during 1 year of follow-up.. Our study cohort consisted of 2422 new users of lithium and 2918 new users of valproate over an 8-year period. There was no statistically significant difference in the incidence of delirium between lithium (2.8 per 100 person-years) and valproate (4.1 per 100 person-years). Compared with patients who received lithium, patients who received benztropine had a significantly higher risk of delirium (p < .001).. The incidence of hospitalizations with delirium was similar in patients treated with lithium and valproate. These findings add to the evidence suggesting that the shift away from the use of lithium carbonate to manage mood disorders in older adults is not justified on the basis of concerns of neurotoxicity.

Topics: Adult; Age Distribution; Age Factors; Aged; Anticonvulsants; Antidepressive Agents; Benztropine; Cohort Studies; Delirium; Drug Prescriptions; Drug Utilization Review; Follow-Up Studies; Humans; Incidence; Lithium Carbonate; Mood Disorders; Neurotoxicity Syndromes; Ontario; Proportional Hazards Models; Treatment Outcome; Valproic Acid

Topics: Adolescent; Benztropine; Delirium; Drug Interactions; Drug Therapy, Combination; Humans; Male; Paroxetine

Topics: 1-Naphthylamine; Adult; Benztropine; Delirium; Depressive Disorder; Drug Interactions; Drug Therapy, Combination; Female; Haloperidol; Humans; Lithium; Parkinson Disease, Secondary; Selective Serotonin Reuptake Inhibitors; Sertraline

Topics: Adult; Age Factors; Aged; Benztropine; Delirium; Drug Interactions; Fluoxetine; Humans; Middle Aged; Perphenazine; Schizophrenia; Selective Serotonin Reuptake Inhibitors

On the basis of recent findings, the increased use of serotonin selective reuptake inhibitors (SSRIs) in combination with antipsychotics and concomitant benztropine is likely.. Five patients who developed delirium while receiving a neuroleptic, an SSRI, and benztropine are described.. The timing of the delirium in relation to drug administration suggests the delirium was the result of an interaction of the SSRI and benztropine.. Possible mechanisms are explored. Clinicians should be aware that patients receiving this combination may be at increased risk for delirium.

Topics: Aged; Antipsychotic Agents; Benztropine; Delirium; Drug Interactions; Drug Therapy, Combination; Female; Humans; Male; Mental Disorders; Middle Aged; Selective Serotonin Reuptake Inhibitors

A continuous intravenous infusion of physostigmine was successfully used in the management of a case of anticholinergic poisoning. In selected patients, intravenous physostigmine can be a safe and specific means of reversing the signs and symptoms of anticholinergic toxicity.

Topics: Adult; Amitriptyline; Benztropine; Delirium; Female; Humans; Infusions, Parenteral; Parasympatholytics; Physostigmine

Topics: Adult; Benztropine; Delirium; Drug Therapy, Combination; Female; Fluphenazine; Humans; Propranolol; Tropanes

1. This report describes two cases of psychotic syndrome from benztropine (Cogentin), which was used to treat haloperidol-induced extrapyramidal side effects. The patients' symptomatology meets DSM III criteria for delirium. Both patients displayed repetitive motor automatisms (stereotypy). 2. Symptomatology appeared one-to-two days after the start of benztropine 2 mg b.i.d. and subsided one-to-several days after benztropine was stopped. Treatment consisted of administration of sedative hypnotic drugs. 3. The literature on anticholinergic-induced psychotic syndromes is surveyed. Particular attention is drawn to the occurrence of stereotypy. 4. It is proposed, on the basis of a review of animal and clinical data, that stereotypies in delirious patients are related to muscarinic blockade in the central nervous system. This model is used to explain repetitive motor automatisms which are seen in Alzheimer's disease. 5. The paper concludes with brief guidelines for the management of anticholinergic delirium.

Topics: Adult; Aged; Benztropine; Delirium; Diazepam; Drug Therapy, Combination; Dyskinesia, Drug-Induced; Ethchlorvynol; Female; Haloperidol; Humans; Imipramine; Phenobarbital; Psychoses, Substance-Induced; Stereotyped Behavior; Substance-Related Disorders; Tropanes

In 13 elderly patients, 12 of whom had Parkinson's disease, visual hallucinations and delirium developed as a side effect of amantadine hydrochloride (Symmetrel) therapy. The symptoms promptly disappearred when amantadine was discontinued. Thereafter, each parkinsonian patient was treated satisfactorily with levo-dopa. Treatment with a combination of amantadine and an anticholinergic agent increases the likelihood of delirium because of the hazard of retention of urine. Although amantadine is effective in the treatment of Parkinson's disease in the elderly, the incidence of delirium as a complication seems higher in this age group.

Topics: Aged; Amantadine; Benztropine; Biperiden; Delirium; Drug Eruptions; Female; Hallucinations; Humans; Levodopa; Male; Middle Aged; Orphenadrine; Parkinson Disease