Anticholinergic syndrome in a patient with schizophrenia
Introduction Anticholinergic syndrome (AS) is a complication that can appear due to different drugs with antimuscarinic effects, such as antihistamines, alkaloids, antipsychotics, tricyclic antidepressives or anesthetics, and it is characterized by urinary retention, dry mouth and skin, mydriasis,...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2022-06-01
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| Series: | European Psychiatry |
| Subjects: | |
| Online Access: | https://www.cambridge.org/core/product/identifier/S0924933822020417/type/journal_article |
| _version_ | 1797616569872809984 |
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| author | O. Marco Estrada L. Tardon T. Fernández L. Navarro M. Bioque N. Arbelo |
| author_facet | O. Marco Estrada L. Tardon T. Fernández L. Navarro M. Bioque N. Arbelo |
| author_sort | O. Marco Estrada |
| collection | DOAJ |
| description |
Introduction
Anticholinergic syndrome (AS) is a complication that can appear due to different drugs with antimuscarinic effects, such as antihistamines, alkaloids, antipsychotics, tricyclic antidepressives or anesthetics, and it is characterized by urinary retention, dry mouth and skin, mydriasis, low-grade fever, and confusion or coma.
Objectives
To describe a clinical case of AS admitted to our hospital.
Methods
We present a case report of a patient with schizophrenia who presented an anticholinergic syndrome. We also searched for previous studies of AS using a pubmed query.
Results
A 53-year-old male was admitted for a psychotic decompensation to another hospital in Barcelona. The usual treatment at home was amisulpride 1200mg/d, olanzapine 30mg/d and lormetazepam, and haloperidol 6mg/d and clotiapine 40mg/d were added to treat the decompensation. Then, the patient started to present mydriasis, mucocutaneous dryness, low-grade fever, slight hypertension and tachycardia, repeated retentions of urine, confusion, unintelligible speech and agitation, so he was referred to our hospital. Once he was admitted, haloperidol was withdrawn and support measures (bladder catheterization, fluid therapy, etc.) were applied. After a few days, most of the mentioned alterations were stabilized, but the psychotic symptoms, such as thought and behavioural disorganization, persisted and required electroconvulsive therapy, with subsequent improvement.
Conclusions
AS is a relatively frequent side effect of psychiatric medication, which diagnosis is clinical, so, we must be capable to identify it and initiate early treatment to prevent possible complications. The first step, as reflected in the case described, is to stop the causative drugs, and apply support measures. Additionally, physostigmine can be used, as it is an effective antidote.
Disclosure
No significant relationships.
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| first_indexed | 2024-03-11T07:43:00Z |
| format | Article |
| id | doaj.art-4174a3afdd0e441db3b8259b35eb2614 |
| institution | Directory Open Access Journal |
| issn | 0924-9338 1778-3585 |
| language | English |
| last_indexed | 2024-03-11T07:43:00Z |
| publishDate | 2022-06-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | European Psychiatry |
| spelling | doaj.art-4174a3afdd0e441db3b8259b35eb26142023-11-17T05:08:08ZengCambridge University PressEuropean Psychiatry0924-93381778-35852022-06-0165S790S79010.1192/j.eurpsy.2022.2041Anticholinergic syndrome in a patient with schizophreniaO. Marco Estrada0L. Tardon1T. Fernández2L. Navarro3M. Bioque4N. Arbelo5Hospital Clínic de Barcelona, Psychiatry, Barcelona, SpainHospital Clínic de Barcelona, Psychiatry, Barcelona, SpainHospital Clínic de Barcelona, Psychiatry, Barcelona, SpainHospital Clínic de Barcelona, Psychiatry, Barcelona, SpainBarcelona Clinic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clinic Of Barcelona, University Of Barcelona, Idibaps, Cibersambarcelona Clinic Schizophrenia Unit (bcsu), Neuroscience Institute, Barcelona, SpainHospital Clínic Barcelona, Psychiatry, Barcelona, Spain Introduction Anticholinergic syndrome (AS) is a complication that can appear due to different drugs with antimuscarinic effects, such as antihistamines, alkaloids, antipsychotics, tricyclic antidepressives or anesthetics, and it is characterized by urinary retention, dry mouth and skin, mydriasis, low-grade fever, and confusion or coma. Objectives To describe a clinical case of AS admitted to our hospital. Methods We present a case report of a patient with schizophrenia who presented an anticholinergic syndrome. We also searched for previous studies of AS using a pubmed query. Results A 53-year-old male was admitted for a psychotic decompensation to another hospital in Barcelona. The usual treatment at home was amisulpride 1200mg/d, olanzapine 30mg/d and lormetazepam, and haloperidol 6mg/d and clotiapine 40mg/d were added to treat the decompensation. Then, the patient started to present mydriasis, mucocutaneous dryness, low-grade fever, slight hypertension and tachycardia, repeated retentions of urine, confusion, unintelligible speech and agitation, so he was referred to our hospital. Once he was admitted, haloperidol was withdrawn and support measures (bladder catheterization, fluid therapy, etc.) were applied. After a few days, most of the mentioned alterations were stabilized, but the psychotic symptoms, such as thought and behavioural disorganization, persisted and required electroconvulsive therapy, with subsequent improvement. Conclusions AS is a relatively frequent side effect of psychiatric medication, which diagnosis is clinical, so, we must be capable to identify it and initiate early treatment to prevent possible complications. The first step, as reflected in the case described, is to stop the causative drugs, and apply support measures. Additionally, physostigmine can be used, as it is an effective antidote. Disclosure No significant relationships. https://www.cambridge.org/core/product/identifier/S0924933822020417/type/journal_articleanticholinergicphysostigmineschizophréniaAntipsychotics |
| spellingShingle | O. Marco Estrada L. Tardon T. Fernández L. Navarro M. Bioque N. Arbelo Anticholinergic syndrome in a patient with schizophrenia European Psychiatry anticholinergic physostigmine schizophrénia Antipsychotics |
| title | Anticholinergic syndrome in a patient with schizophrenia |
| title_full | Anticholinergic syndrome in a patient with schizophrenia |
| title_fullStr | Anticholinergic syndrome in a patient with schizophrenia |
| title_full_unstemmed | Anticholinergic syndrome in a patient with schizophrenia |
| title_short | Anticholinergic syndrome in a patient with schizophrenia |
| title_sort | anticholinergic syndrome in a patient with schizophrenia |
| topic | anticholinergic physostigmine schizophrénia Antipsychotics |
| url | https://www.cambridge.org/core/product/identifier/S0924933822020417/type/journal_article |
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