benztropine and Syndrome

A case of acute dystonia related to rivastigmine use is reported.. A 61-year-old Caucasian woman who had suffered from bipolar II disorder with rapid cycling for over 30 years was admitted to an inpatient psychiatry unit. In addition to bipolar II disorder, the patient had been previously diagnosed with early-stage Alzheimer's disease, posttraumatic stress disorder, and various anxiety disorders. During the current hospitalization, she was taking clonazepam, dextroamphetamine, lamotrigine, lansoprazole, levothyroxine, memantine, quetiapine, risperidone, rivastigmine, tranylcypromine, trazodone, and zolpidem. Soon after hospital admission, she began to complain of a tightening in her chest. A review of her records revealed similar complaints during previous hospitalizations. Rivastigmine was discontinued due to concerns of interactions with her antipsychotic regimen. Although these symptoms were previously attributed to anxiety, they appeared worse during this hospitalization. During these events she would be witnessed lying in bed in a supine position with her head canted posteriorly. Benztropine was given to help determine if she was having a dystonic reaction. Within 30 minutes, her chest discomfort began to resolve, and her symptoms resolved completely over the next 48 hours. Three days later, rivastigmine was restarted by the attending psychiatrist because of concerns about the patient's memory, and the dystonia-like symptoms returned within 2 hours of her morning dose. Rivastigmine was discontinued, and benztropine was given and then discontinued, with no return of symptoms for the remainder of her two-week hospitalization.. A patient with bipolar II disorder and mild-to-moderate Alzheimer's disease developed dystonia, possibly caused by rivastigmine. However, the patient was taking various other medications that could have lowered the threshold for extrapyramidal syndromes.

Topics: Acute Disease; Alzheimer Disease; Antipsychotic Agents; Benztropine; Cholinesterase Inhibitors; Comorbidity; Cyclothymic Disorder; Drug Interactions; Dystonia; Extrapyramidal Tracts; Female; Humans; Middle Aged; Phenylcarbamates; Rivastigmine; Syndrome

Anticholinergic syndrome can develop in multiple clinical situations. The disturbance of the central nervous system muscarinic transmission by acetylcholine antagonists or lack of acetylcholine can result in this unpredictable behavioral syndrome. Health care professionals should do the following: Be familiar with common drugs or drug combinations that may induce this condition; Be aware of patients who may be at greatest risk; Be able to identify the cluster of signs and symptoms of anticholinergic toxicity; and Implement appropriate nursing treatment interventions for patients with anticholinergic syndrome. Because this condition is constantly changing, it often is misdiagnosed. Much remains to be studied and understood about the neurophysiology of this condition. Central cholinergic transmission is blocked with the use of many anticholinergic drugs in numerous patient settings. Because acetylcholine plays a significant role in modulating the interactions among most other central transmitters, excessive blockage of this neurotransmitter may result in the unpredictable behavioral condition known as anticholinergic syndrome.

Topics: Adolescent; Benztropine; Cholinergic Antagonists; Dose-Response Relationship, Drug; Drug Therapy, Combination; Dyskinesia, Drug-Induced; Haloperidol; Humans; Male; Nursing Diagnosis; Psychoses, Substance-Induced; Risk Factors; Syndrome

The case history presented illustrates that, following an overdose of 'Whizz' and alcohol, a protracted dystonic syndrome can develop, clinically indistinguishable from tetanus. A prolonged period of ventilation may be necessary, but, in this case, complete recovery eventually occurred.

Topics: Adult; Alcoholic Intoxication; Amphetamines; Benztropine; Diagnosis, Differential; Drug Overdose; Dystonia; Ethanol; Humans; Male; Procyclidine; Syndrome; Tetanus

A 27-year-old neuroleptic-stabilised schizophrenic patient presented with a three-day history of psychomotor retardation, disturbed sleep, and social and emotional withdrawal following reduction of his anticholinergic dosage; his symptoms had intensified after an increase in neuroleptic dosage, based on a diagnosis of psychotic decompensation. Recognition of a cholinergic syndrome and institution of appropriate anticholinergic treatment resulted in rapid improvement. The clinical distinction between a cholinergic overdrive state and schizophrenic exacerbation, while sometimes difficult, can be critical in selecting appropriate management.

Topics: Adult; Benztropine; Brain; Humans; Imipramine; Male; Marijuana Abuse; Receptors, Cholinergic; Schizophrenia, Paranoid; Substance Withdrawal Syndrome; Substance-Related Disorders; Syndrome; Thiothixene; Tropanes

In 3 patients who suffered oculogyric crises, mental changes accompanied upward deviation of the eyes. In 1 patient, whom we studied in detail, the mental disturbance consisted of a disorder of attention in which pathological fixation of a thought occurred. During the period of upward eye deviation, all functional types of conjugate eye movements were present in the upper field of gaze, suggesting an imbalance of the vertical gaze-holding mechanism. The eyes could be driven down only by a combined blink and downward saccade. Both the thought disorder and the ocular deviation responded promptly to anticholinergic agents. We propose that the disorders of thought and eye movement in oculogyric crisis are linked by a pharmacological imbalance common to both.

Topics: Adult; Benztropine; Cognition Disorders; Diphenhydramine; Eye Movements; Female; Humans; Male; Middle Aged; Parasympatholytics; Syndrome

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

Topics: Animals; Benztropine; Biperiden; Cebus; Disease Models, Animal; Dyskinesia, Drug-Induced; Female; Fluphenazine; Macaca; Male; Parasympatholytics; Species Specificity; Syndrome

Topics: Aged; Benztropine; Depressive Disorder; Humans; Male; Parasympatholytics; Physostigmine; Syndrome; Thiothixene; Urination Disorders

Blepharospasm and oromandibular dystonia are clinically similar to other hyperkinetic movement disorders. Dopaminergic antagonist (neuroleptic) and purported cholinergic agonist (deanol) treatment improved symptoms, whereas dopaminergic agonist (carbidopa/levodopa) and cholinergic antagonist (benztropine) drugs worsened symptoms in two patients. This suggested that the syndrome is also pharmacologically related to the hyperkinetic dyskinesias. Symptoms worsened substantially during carbidopa/levodopa but temporarily resolved in one patient and improved in another when the drug was discontinued. This suggests that the pathophysiology of these symptoms involves an idiopathic form of receptor hypersensitivity that can be modified by agonist treatment. The effect of cholinergic agents was less than the effect of dopaminergic drugs, implying that dopamine plays a predominant role in the pathophysiology.

Topics: Aged; Benztropine; Blepharospasm; Carbidopa; Deanol; Drug Therapy, Combination; Electromyography; Eyelid Diseases; Humans; Jaw Diseases; Levodopa; Male; Middle Aged; Movement Disorders; Syndrome

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

We reviewed the use of physostigmine in the diagnosis and management of acute toxic psychosis due to drugs with anticholinergic properties. The syndrome of agitation and toxic confusional psychosis associated with peripheral signs of cholinergic blockade is produced by several plant toxins, antispasmodics, ophthalmic preparations, and certain proprietary sedatives, as well as antiparkinson medications, antidepressants, and some antipsychotic drugs. Physostigmine, uniquely among the available reversible anticholinesterase agents, can pass the blood-brain barrier to exert central as well as peripheral cholinomimetic actions to reverse this syndrome. Psychiatrists should make more use of this safe, specific, rapid, and effective treatment for anticholinergic drug toxicity, and should particularly be alert to reversible anticholinergic brain syndromes associated with antidepressants and antiparkinson medications, and even with antipsychotic medications.

Topics: Acute Disease; Adult; Amitriptyline; Benztropine; Chemical Phenomena; Chemistry; Cholinesterase Inhibitors; Doxepin; Female; Haloperidol; Humans; Male; Nervous System Diseases; Parasympatholytics; Physostigmine; Psychoses, Substance-Induced; Syndrome; Thioridazine

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

Topics: Aged; Anxiety; Basal Ganglia Diseases; Benztropine; Chlorpromazine; Fatigue; Female; Humans; Male; Masticatory Muscles; Middle Aged; Mouth; Movement Disorders; Perphenazine; Procyclidine; Reserpine; Schizophrenia; Syndrome; Tranquilizing Agents; Trifluoperazine; Trihexyphenidyl