benztropine and Parkinson-Disease--Secondary

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

Serum perphenazine concentrations and early resolution of psychosis were examined to determine if blood level monitoring could be used to maximize drug efficacy while limiting extrapyramidal side effects (EPS). Sixty-six acutely psychotic inpatients were given perphenazine 0.5 mg/kg/day for 10 days, and their response was rated blind to blood level. Although 36 of 66 patients showed resolution of psychosis, neither perphenazine nor N-dealkylated perphenazine levels were related to global response or to Brief Psychiatric Rating Scale (BPRS) totals. Improvement in two individual BPRS items (hallucinations and conceptual disorganization) was related to serum perphenazine levels and suggestive of a lower therapeutic threshold of 0.8 ng/mL. Perphenazine level was not correlated with EPS; but benztropine, given only if required for serious EPS, was more likely to be used when perphenazine levels were elevated. The data suggest that higher perphenazine levels were no more effective than moderate levels but that higher levels may be associated with increased EPS; the data also suggest that individual symptoms rather than global response were associated with a lower therapeutic perphenazine threshold.

Topics: Adult; Akathisia, Drug-Induced; Basal Ganglia Diseases; Benztropine; Clinical Trials as Topic; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Hospitalization; Humans; Male; Parkinson Disease, Secondary; Perphenazine; Psychiatric Status Rating Scales; Psychotic Disorders; Schizophrenia; Schizophrenic Psychology

In a 12-week controlled study ethopropazine was compared to benztropine in the treatment of parkinsonism induced by fluphenazine enanthate in 60 schizophrenic outpatients. Ethopropazine and benztropine were found to be equally effective in controlling parkinsonian symptoms and were as efficacious as procyclidine, their previous antiparkinsonian drug. However, benztropine treated patients had a significant increase in tardive dyskinesia compared to their condition during procyclindine treatment, and significantly more anxiety and depression than ethopropazine treated patients. This suggests that benztropine is not the anticholinergic drug of choice in the treatment of neuroleptic-induced parkinsonian symptoms, because of its more toxic central and peripheral atropinic effect.

Topics: Adult; Benztropine; Clinical Trials as Topic; Double-Blind Method; Dyskinesia, Drug-Induced; Female; Fluphenazine; Humans; Male; Middle Aged; Parkinson Disease, Secondary; Phenothiazines; Procyclidine; Schizophrenia; 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: Administration, Oral; Amantadine; Antiparkinson Agents; Benztropine; Capsules; Chlorpromazine; Clinical Trials as Topic; Humans; Parkinson Disease; Parkinson Disease, Secondary; Placebos; Schizophrenia; Time Factors

We describe six patients with parkinsonism and another 10 patients with parkinsonian features with human immunodeficiency virus (HIV) infection. In 50% of these patients, the symptoms were precipitated by neuroleptics. In the remaining patients, no obvious cause other than HIV infection was identified. Discontinuation of the neuroleptics produced complete recovery in one patient and partial or no response in others. Rapid progression of parkinsonism was noted in two patients, one of whom was treated with high-dose zidovudine (AZT) and benztropine. We conclude that patients with AIDS are at risk of developing an akinetic parkinsonism which may be precipitated by the use of neuroleptics, response to treatment is variable, and parkinsonism may be another primary HIV-induced syndrome.

Topics: Adult; AIDS Dementia Complex; AIDS-Related Opportunistic Infections; Anti-HIV Agents; Antipsychotic Agents; Benztropine; Drug Therapy, Combination; HIV Infections; Homosexuality, Male; Humans; Male; Neurologic Examination; Parkinson Disease, Secondary; Risk Factors; Zidovudine

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

Depression is commonly associated with the longitudinal course of schizophrenia. Several etiologies for this problem have been proposed but, to our knowledge, noncompliance with antiparkinsonian medications has not been considered.. Case histories of two patients who were noncompliant and one who threatened noncompliance with antiparkinsonian medications are presented. All three patients were diagnosed with schizophrenia by DSM-III-R criteria and had been clinically stable for long periods.. All three patients became depressed when their adjunctive benztropine was stopped, and their depressions remitted when their benztropine was reinstated.. Noncompliance with antiparkinsonian medications may be associated with a reversible depression in patients receiving maintenance neuroleptics for schizophrenia. Since this is a newly described phenomenon, the scope of the problem is not known; however, it may contribute to the wide prevalence of depressive symptoms in schizophrenia. Clinical measures to facilitate detection of such noncompliance are discussed.

Topics: Adult; Antiparkinson Agents; Antipsychotic Agents; Basal Ganglia Diseases; Benztropine; Depressive Disorder; Dyskinesia, Drug-Induced; Female; Humans; Male; Parkinson Disease, Secondary; Schizophrenia; Treatment Refusal

Susceptibility to neuroleptic-induced extrapyramidal syndromes varies widely, even within age and sex subgroups. Individual vulnerability to extrapyramidal syndromes has been assumed to explain this, but the utility of past history for predicting future occurrence of extrapyramidal syndromes has not been studied extensively. This investigation was undertaken to determine whether patients' previous histories of extrapyramidal syndromes predict future episodes of extrapyramidal syndromes and to compare the importance of this predictive factor with patient age, sex, neuroleptic dose, and anticholinergic dose as predictors of extrapyramidal syndromes.. The charts of 62 schizophrenic patients with multiple neuroleptic treatment episodes were reviewed. Extrapyramidal syndromes, neuroleptic drug doses, and anticholinergic drug doses during the first 21 days of each treatment episode were recorded.. Previous extrapyramidal syndromes correctly predicted extrapyramidal syndromes in subsequent treatments for 84% of the patients. Variations in neuroleptic potency, neuroleptic dose, and anticholinergic dose partially explained incorrect predictions.. These results support the hypothesis that patients with a history of extrapyramidal syndromes are at greater risk for future extrapyramidal syndromes. If confirmed, these results strongly support individual susceptibility as a major predictor of extrapyramidal syndromes and indicate that prophylaxis of extrapyramidal syndromes should be considered for patients who have previously suffered extrapyramidal syndromes from similarly prescribed neuroleptic therapy.

Topics: Adult; Age Factors; Antipsychotic Agents; Basal Ganglia Diseases; Benztropine; Chlorpromazine; Disease Susceptibility; Female; Humans; Male; Medical Records; Parkinson Disease, Secondary; Probability; Recurrence; Risk Factors; Sex Factors

The tendency of antipsychotics to produce extrapyramidal side-effects varies inversely with their antimuscarinic activity. This paper reviews the antipsychotic and antimuscarinic potency of these drugs and compares the total antimuscarinic activity in standard daily doses of antipsychotics, antiparkinson agents and antidepressants. The authors examine factors associated with tolerance of benztropine withdrawal in 39 inpatients. Patients with serious EPS relapse after benztropine withdrawal had an excess of antipsychotic over antimuscarinic activity in their remaining medications. The results suggest an optimal ratio between total antipsychotic and anticholinergic doses, and a simple model for predicting antiparkinson drug requirements.

Topics: Adult; Antiparkinson Agents; Antipsychotic Agents; Benztropine; Brain; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Parkinson Disease, Secondary; Receptors, Cholinergic; Receptors, Muscarinic; Schizophrenia; Substance Withdrawal Syndrome

Topics: Benztropine; Dyskinesia, Drug-Induced; Haloperidol; Humans; Parkinson Disease, Secondary; Tourette Syndrome

A case report is presented of a patient with remitting tardive dyskinesia coexistent with neuroleptic-induced parkinsonism. The patient received benztropine and physostigmine challenges on successive days and the effects on both syndromes are described. The clinical course of both diseases is discussed in terms of a balance hypothesis between dopaminergic and cholinergic neurotransmission.

Topics: Acetylcholine; Adult; Benztropine; Corpus Striatum; Dopamine; Dyskinesia, Drug-Induced; Fluphenazine; Haloperidol; Humans; Male; Parkinson Disease, Secondary; Physostigmine; Schizophrenia, Paranoid; Thioridazine; Tranquilizing Agents

Topics: Animals; Atropine; Benztropine; Butyrophenones; Cats; Chlorpromazine; Dose-Response Relationship, Drug; Electromyography; Motor Neurons; Parkinson Disease; Parkinson Disease, Secondary; Phenothiazines; Rabbits; Rats; Reserpine; Tetanus; Time Factors; Tremorine; Trifluoperazine

Topics: Animals; Basal Ganglia Diseases; Benztropine; Carbon Isotopes; Chromatography, Thin Layer; Feces; Female; Fluphenazine; Half-Life; Haplorhini; Papio; Parkinson Disease; Parkinson Disease, Secondary; Trihexyphenidyl