benztropine and Mental-Disorders

Topics: Agranulocytosis; Barbiturates; Basal Ganglia Diseases; Benztropine; Biperiden; Delayed-Action Preparations; Depression; Diazepam; Drug Interactions; Eye Manifestations; Fatty Acids; Female; Fluphenazine; Humans; Jaundice; Male; Mental Disorders; Movement Disorders; Parkinson Disease, Secondary; Schizophrenia; Seizures; Skin Manifestations

Intravenous sedation of involuntary psychiatric patients is practised in almost all hospitals in New South Wales. Despite its widespread use, little has been published about the medications used or their safety and efficacy. The present study reports the frequency and reasons for intravenous sedation, the medications used, and the incidence of adverse effects.. Eighteen of 21 acute psychiatric admission units in the State were reviewed. The medical records of a random sample of 495 patients admitted involuntarily during 1990 were examined and information from the progress notes, drug charts and physical observations was recorded and subjected to statistical analysis.. Of the 495 patients, 132 (27%) were intravenously sedated. Eighty-six percent (86%) of patients received a combination of haloperidol or diazepam, usually 20 mg of each drug. The threat of violence was the most significant patient characteristic predicting the use of intravenous sedation. Patients with mania or intoxication were relatively more likely to be intravenously sedated than other diagnostic categories. Patients admitted via accident and emergency departments and those admitted to teaching and metropolitan general hospitals compared to rural and large psychiatric hospitals were significantly more likely to receive intravenous sedation. The most common complications of intravenous sedation were dystonia (37%), hypotension (8%) and confusion (5%). The incidence of phlebitis and other extrapyramidal side-effects was probably under-reported.. About one in four involuntary psychiatric patients receive intravenous sedation in NSW. Intravenous sedation is more likely when patients are admitted through accident and emergency departments to teaching or metropolitan hospitals, and pose a threat of violence. Intravenous sedation was shown to be a safe procedure given certain precautions.

Topics: Adult; Benztropine; Commitment of Mentally Ill; Diazepam; Drug Utilization; Emergency Services, Psychiatric; Female; Haloperidol; Humans; Hypnotics and Sedatives; Injections, Intravenous; Male; Mental Disorders; Midazolam; Retrospective Studies; Violence

Studies on the withdrawal of anticholinergics from patients on antipsychotics have produced conflicting results. This 12-week study employed a double-blind crossover design on 39 adult in-patients selected from a total hospital population of 620. The Colombia Scale was used to determine extrapyramidal side effects (EPS). All patients were stabilised prior to the study on benztropine mesylate 2 mg b.i.d., and gradual withdrawal was employed. Benztropine withdrawal produced a significant increase in overall EPS scores. Ten patients (26%) required reinstatement of benztropine while on placebo. Sialorrhoea, rigidity and postural instability were the most prominent changes. Neither age, sex, nor diagnosis were significantly predictive of EPS. Depot medications and doses greater than 1000 mg/day chlorpromazine-equivalent were related to significant EPS increase. The intrinsic anticholinergic properties of the antipsychotics themselves and concomitant medications, such as antidepressants, appeared protective against development of EPS. Most patients on a combination of antipsychotics and anticholinergics can safely be withdrawn from the latter.

Topics: Adult; Antipsychotic Agents; Benztropine; Clinical Trials as Topic; Double-Blind Method; Dyskinesia, Drug-Induced; Humans; Long-Term Care; Mental Disorders; Middle Aged; Parasympatholytics; Schizophrenia; Substance Withdrawal Syndrome

Topics: Antiparkinson Agents; Benztropine; Clinical Trials as Topic; Drug Interactions; Drug Therapy, Combination; Humans; Mental Disorders; Parasympatholytics; Phenothiazines; Tropanes

Topics: Aged; Benztropine; Brain; Clinical Trials as Topic; Depression; Dihydroxyphenylalanine; Evaluation Studies as Topic; Fatigue; Female; Fenclonine; Humans; Male; Mental Disorders; Middle Aged; Nausea; Parkinson Disease; Placebos; Serotonin; Sleep Initiation and Maintenance Disorders

The aim of this study was to estimate the prevalence of first-generation antipsychotics (FGA) prescribed for treatment of psychiatric and neurological conditions and use of benztropine to reduce extrapyramidal side effects (EPS) by patient race/ethnicity in a nationally representative sample of adult outpatient visits.. The study sample included all outpatient visits (N = 8154) among patients aged 18-69 years where a prescription for one or more antipsychotics was recorded across 6 years of the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (2005-2010). Use of FGA was compared by race/ethnicity using multiple logistic regression models accounting for patient and clinical characteristics stratified by neighborhood poverty rate. Frequency of EPS was determined by use of benztropine to reduce or prevent EPS.. Black patients were significantly more likely than White patients to use FGA (odds ratio = 1.48, p = 0.040) accounting for psychiatric and neurological diagnoses, treatment setting, metabolic factors, neighborhood poverty, and payer source. Black patients were more than twice as likely as White patients to receive higher-potency FGA (haloperidol or fluphenazine), particularly in higher-poverty areas (odds ratio = 2.50, p < 0.001). Use of FGA, higher among Black than White patients, was positively associated with use of benztropine to reduce EPS.. Racial disparities in the pharmacological treatment of severe mental disorders persist 30 years after the introduction of second-generation antipsychotics. The relatively high frequency of FGA of use among Black patients compared with White patients despite more Food and Drug Administration-approved indications and lower EPS risk for second-generation antipsychotics requires additional research.

Topics: Adolescent; Adult; Aged; Ambulatory Care; Antipsychotic Agents; Benztropine; Black or African American; Female; Health Care Surveys; Healthcare Disparities; Humans; Logistic Models; Male; Mental Disorders; Middle Aged; Poverty Areas; Practice Patterns, Physicians'; Racial Groups; United States; White People; Young Adult

Topics: Antipsychotic Agents; Benztropine; Dopamine Uptake Inhibitors; Drug Administration Schedule; Humans; Mental Disorders

Topics: Adolescent; Benztropine; Dopamine Uptake Inhibitors; Esotropia; Female; Humans; Mental Disorders; Mydriasis; Pseudohypoaldosteronism

Topics: Antipsychotic Agents; Basal Ganglia Diseases; Benztropine; Cholinergic Antagonists; Cost Savings; Diphenhydramine; Drug Costs; Drugs, Generic; Hospital Costs; Humans; Injections, Intramuscular; Mental Disorders; Pharmacy Service, Hospital

This study assessed misuse of anticholinergic drugs in a population of 50 patients with serious mental illness who were assertively managed by a community-based outreach team in Sydney, Australia. One-third of the subjects reported having misused anticholinergics over the previous month. All anticholinergics were misused, and trihexyphenidyl (benzhexol) was misused most frequently. Most subjects misused at least one other drug as well. On direct questioning, the reason given most frequently was "to get high"; on indirect questioning, reasons were related more to peer participation and feelings of futility. Marginalized patients living in the community are vulnerable to the misuse of anticholinergic drugs.

Topics: Adult; Benztropine; Female; Humans; Illicit Drugs; Male; Mental Disorders; Muscarinic Antagonists; New South Wales; Orphenadrine; Prevalence; Procyclidine; Substance-Related Disorders; Trihexyphenidyl

Topics: Administration, Oral; Antiparkinson Agents; Antipsychotic Agents; Benztropine; Drug Therapy, Combination; Haloperidol; Humans; Injections, Intramuscular; Managed Care Programs; Mental Disorders; Severity of Illness Index

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

Topics: Animals; Benztropine; Drug Interactions; Humans; Mental Disorders; Parasympatholytics; Psychotropic Drugs; Therapeutic Equivalency; Water-Electrolyte Balance

A 27-year-old man was admitted to the emergency department with a fluphenazine decanoate-induced dystonia. He was treated with 125 mg diphenhydramine IV in four doses and 2 mg benztropine IM. A fluctuating response was observed before continued remission of the dystonia. Possible reasons for variable patient responses to diphenhydramine are discussed.

Topics: Adult; Benztropine; Delayed-Action Preparations; Diphenhydramine; Dystonia; Fluphenazine; Humans; Male; Mental Disorders

Topics: Antidepressive Agents; Antipsychotic Agents; Benztropine; Butyrophenones; Community Mental Health Services; Female; Glaucoma; Humans; Intraocular Pressure; Male; Mental Disorders; Phenothiazines; Trihexyphenidyl

Topics: Amitriptyline; Benztropine; Brain; Doxepin; Haloperidol; Humans; Injections, Intramuscular; Mental Disorders; Parasympatholytics; Physostigmine; Thioridazine

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; Age Factors; Antiparkinson Agents; Basal Ganglia Diseases; Benztropine; Female; Fluphenazine; Humans; Injections; Male; Massachusetts; Mental Disorders; Middle Aged; Residential Treatment; Schizophrenia; Sex Factors; Time Factors; Tropanes

Topics: Adult; Antiparkinson Agents; Benztropine; Chlorpromazine; Heat Exhaustion; Humans; Male; Mental Disorders; Middle Aged; Tropanes

Topics: Benztropine; Dementia; France; Geriatrics; Mental Disorders; Parasympatholytics; Parkinsonian Disorders; Psychotic Disorders; Toxicology; Tranquilizing Agents