Delirium secondary to anticholinergics

Annalise Bellizzi, Elyse Mercieca, Catherine Dimech
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Abstract

In conjunction with BMJ Case Reports , DTB will feature occasional drug-related cases that are likely to be of interest to readers. These will include cases that involve recently marketed drugs for which there is limited knowledge of adverse effects and cases that highlight unusual reactions to drugs that have been marketed for several years. We present a case of a young man who developed sudden deterioration in his physical and mental state whilst being treated as an inpatient for substance-induced psychosis. This deterioration was manifested by sudden disorientation, change in behaviour and visual hallucinations. It was only after excluding other potential causes that this presentation was attributed to the regular administration of procyclidine that was being used to counteract the extrapyramidal side effects from antipsychotics. The patient showed a dramatic improvement on stopping procyclidine. This case highlights the importance of awareness of rare adverse drug reactions and the resultant distressing effect for the patient himself. Antipsychotics are the mainstay of treatment of psychosis. They are well known for their extrapyramidal side effects (EPSEs) that greatly impact a patient’s well-being, including stiffness, tremor, difficulty eating and writing. Procyclidine is commonly prescribed to alleviate EPSEs. It does so by inhibiting the action of acetylcholine at the muscarinic receptor, hence minimising its excitatory effects.1 Reported side effects of procyclidine include most commonly drowsiness, dizziness, constipation, flushing, nausea, nervousness, blurred vision and dry mouth. Rarely, it is reported to cause abdominal pain, difficulty swallowing, urinary retention, weakness, chest pain, fainting, fever, tachycardia, arrhythmias, change in mental state (such as confusion, hallucinations, memory problems), mydriasis and visual changes.1 2 Being an anticholinergic, anticholinergic delirium is a possible, although rare, adverse effect of procyclidine. Following the use of Adverse Drug Reaction Probability Scale,3 this case report illustrates a probable procyclidine-induced delirium in …
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继发于抗胆碱能药物的谵妄
DTB 将与 BMJ 病例报告合作,不定期刊登读者可能感兴趣的药物相关病例。这些病例包括近期上市的药物(对其不良反应了解有限),以及已上市数年的药物的异常反应。我们介绍了一个年轻男子的病例,他在接受药物诱发的精神病住院治疗期间,身体和精神状态突然恶化。这种恶化表现为突然迷失方向、行为改变和视觉幻觉。在排除了其他可能的原因后,这一症状才被归因于定期服用普罗环利定来对抗抗精神病药物的锥体外系副作用。停用丙环利定后,患者的病情有了明显好转。这个病例突出了认识罕见药物不良反应的重要性,以及由此给患者本人带来的痛苦。抗精神病药物是治疗精神病的主要药物。众所周知,抗精神病药物的锥体外系副作用(EPSE)会严重影响患者的健康,包括僵硬、震颤、进食和书写困难。普罗环利定是缓解 EPSE 的常用处方药。它通过抑制乙酰胆碱在毒蕈碱受体上的作用,从而将其兴奋作用降至最低。1 据报道,普罗环利定的副作用通常包括嗜睡、头晕、便秘、脸红、恶心、紧张、视力模糊和口干。1 据报道,普罗环利定最常见的副作用包括嗜睡、眩晕、便秘、脸红、恶心、紧张、视力模糊和口干,罕见的副作用包括腹痛、吞咽困难、尿潴留、虚弱、胸痛、昏厥、发热、心动过速、心律失常、精神状态改变(如精神错乱、幻觉、记忆问题)、眼花和视力改变。根据药物不良反应概率表3 ,本病例报告说明了普罗环利定可能诱发的谵妄。
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Drug and Therapeutics Bulletin
Drug and Therapeutics Bulletin Medicine-Pharmacology (medical)
CiteScore
0.80
自引率
0.00%
发文量
69
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