scholarly journals Irreversible effects of anticholinergic withdrawal in the elderly: a case report

2021 ◽  
Vol 3 (2) ◽  
pp. 28-31
Author(s):  
Charisse Chehovich ◽  
Keyword(s):  
Side Effects ◽  
First Generation ◽  
The Elderly ◽  
Anticholinergic Drugs ◽  
Extrapyramidal Side Effects ◽  
Abrupt Withdrawal ◽  
Acute Hospitalization ◽  
Anticholinergic Effects ◽  
Irreversible Effects ◽  
Withdrawal Effects

Anticholinergics, such as benztropine and trihexyphenidyl, are a class of medications that have been used to treat several different conditions including antipsychotic-induced extrapyramidal side effects (EPS) that are most often associated with first-generation antipsychotics (FGAs), such as haloperidol and fluphenazine. Many other medications, including antimuscarinics, antipsychotics, and antidepressants, also have anticholinergic effects. In this report, we review the case of an 80-year-old male who experiences irreversible anticholinergic withdrawal effects following the discontinuation of trihexyphenidyl and trospium secondary to side effects. Discontinuation of anticholinergics must be approached with care as abrupt withdrawal can lead to cholinergic rebound and muscular rigidity, and in some cases can lead to acute hospitalization and an inability to return to baseline functioning, as seen in our elderly patient. Keywords: Anticholinergic withdrawal, trihexyphenidyl, trihexyphenidyl withdrawal, trospium, anticholinergic drugs, cholinergic rebound

Neuroleptic Prescription for Chinese Schizophrenics in Hong Kong

1992 ◽  
Vol 26 (2) ◽  
pp. 262-264 ◽  
Author(s):  
Helen Chiu ◽  
Sing Lee ◽  
C.M. Leung ◽  
Y.K. Wing
Keyword(s):  
Hong Kong ◽  
Side Effects ◽  
High Frequency ◽  
Anticholinergic Drugs ◽  
Extrapyramidal Side Effects ◽  
High Potency ◽  
Frequency Of Use ◽  
Daily Dose ◽  
Schizophrenic Patients ◽  
The Mean

There are very few studies on the pattern of neuroleptic prescription for schizophrenics in Asia. 106 schizophrenic patients in a psychiatric unit of a general teaching hospital in Hong Kong were surveyed. The mean daily dose (in chlorpromazine equivalent) was low (568.5mg). The mean daily dose of high potency agents was four times that of low potency agents. A high frequency of use of anticholinergic drugs may indicate that Chinese are more susceptible to acute extrapyramidal side-effects.

scholarly journals Extrapyramidal side-effects of antipsychotics in a randomised trial

2008 ◽  
Vol 193 (4) ◽  
pp. 279-288 ◽  
Author(s):  
Del D. Miller ◽  
Stanley N. Caroff ◽  
Sonia M. Davis ◽  
Robert A. Rosenheck ◽  
Joseph P. McEvoy ◽  
...  
Keyword(s):  
Side Effects ◽  
Concomitant Medication ◽  
First Generation ◽  
Second Generation ◽  
Rating Scales ◽  
Mixed Model ◽  
Randomised Trial ◽  
Extrapyramidal Side Effects ◽  
Second Generation Antipsychotics ◽  
Secondary Analyses

BackgroundThere are claims that second-generation antipsychotics produce fewer extrapyramidal side-effects (EPS) compared with first-generation drugs.AimsTo compare the incidence of treatment-emergent EPS between second-generation antipsychotics and perphenazine in people with schizophrenia.MethodIncidence analyses integrated data from standardised rating scales and documented use of concomitant medication or treatment discontinuation for EPS events. Mixed model analyses of change in rating scales from baseline were also conducted.ResultsThere were no significant differences in incidence or change in rating scales for parkinsonism, dystonia, akathisia or tardive dyskinesia when comparing second-generation antipsychotics with perphenazine or comparing between second-generation antipsychotics. Secondary analyses revealed greater rates of concomitant antiparkinsonism medication among individuals on risperidone and lower rates among individuals on quetiapine, and lower rates of discontinuation because of parkinsonism among people on quetiapine and ziprasidone. There was a trend for a greater likelihood of concomitant medication for akathisia among individuals on risperidone and perphenazine.ConclusionsThe incidence of treatment-emergent EPS and change in EPS ratings indicated that there are no significant differences between second-generation antipsychotics and perphenazine or between second-generation antipsychotics in people with schizophrenia.

scholarly journals Trends of Anticholinergics and Antipsychotics Prescribing at Chainama Hills College Hospital, Lusaka-Zambia

2021 ◽  
Vol 3 (2) ◽  
pp. 24-31
Author(s):  
Francisca T Bwalya ◽  
◽  
James Mwanza ◽  
Paul Ravi ◽  
◽  
...  
Keyword(s):  
Side Effects ◽  
Atypical Antipsychotic ◽  
Treatment Guidelines ◽  
Anticholinergic Drug ◽  
Antipsychotic Treatment ◽  
High Dose ◽  
Anticholinergic Drugs ◽  
Typical Antipsychotic ◽  
Extrapyramidal Side Effects ◽  
College Hospital

Introduction:Antipsychotics are the main pharmacological treatment for psychosis. Anticholinergic drugs are sometimes prescribed with antipsychotics to treat or as prophylaxis for extrapyramidal side effects. Antipsychotic treatment guidelines recommend that anticholinergics should not be prescribed indiscriminately as prophylaxis for extrapyramidal side effects to patients using antipsychotic drugs, but only when there is high risk or evidence of extrapyramidal side effects, as they can cause significant central and peripheral side effects which have a potential to affect treatment outcomes. The objective of the study was to assess the trends in the prescribing of antipsychotics and anticholinergics.Methods:A cross sectional study was conducted at Chainama Hills College Hospital in Zambia. An open-ended questionnaire was administered to 26 prescribers and 311 files for patients were reviewed who had an antipsychotic or anticholinergic drug prescribed. The prescription pattern of patient files was compared with theNational Institute for Health and Care Excellenceguidelines as a gold standard.Results:The antipsychotic distribution showed that 76.1% were prescribed a typical antipsychotic, 18.1% an atypical antipsychotic and 5.8% were on both typical and atypical antipsychotic. 28.2% of the patients on antipsychotics were prescribed anticholinergics (Trihexyphenidyl). 46.2% of the prescribing clinicians stated that they prescribe anticholinergics when a patient develops extrapyramidal side effects rather than concurrently with antipsychotics or when a high dose of antipsychotics has been prescribed.Conclusion:The trend in antipsychotic and anticholinergic prescribing in Lusaka-Zambia were not consistent with recommended guidelines. Majority of patients are on typical antipsychotics rather than atypical antipsychotics. Most patients were administered above optimal dose of antipsychotics though polypharmacy was solemnly practiced. Recommend that further studies to explore factors contributing to this trend are conducted.

scholarly journals Understanding the Effects of Antipsychotics on Appetite Control

2022 ◽  
Vol 8 ◽  
Author(s):  
Sayani Mukherjee ◽  
Silje Skrede ◽  
Edward Milbank ◽  
Ramaroson Andriantsitohaina ◽  
Miguel López ◽  
...  
Keyword(s):  
Side Effects ◽  
Receptor Binding ◽  
First Generation ◽  
Antipsychotic Drugs ◽  
Molecular Mechanisms ◽  
Extrapyramidal Side Effects ◽  
Appetite Control ◽  
Drug Induced ◽  
Increased Risk

Antipsychotic drugs (APDs) represent a cornerstone in the treatment of schizophrenia and other psychoses. The effectiveness of the first generation (typical) APDs are hampered by so-called extrapyramidal side effects, and they have gradually been replaced by second (atypical) and third-generation APDs, with less extrapyramidal side effects and, in some cases, improved efficacy. However, the use of many of the current APDs has been limited due to their propensity to stimulate appetite, weight gain, and increased risk for developing type 2 diabetes and cardiovascular disease in this patient group. The mechanisms behind the appetite-stimulating effects of the various APDs are not fully elucidated, partly because their diverse receptor binding profiles may affect different downstream pathways. It is critical to identify the molecular mechanisms underlying drug-induced hyperphagia, both because this may lead to the development of new APDs, with lower appetite-stimulating effects but also because such insight may provide new knowledge about appetite regulation in general. Hence, in this review, we discuss the receptor binding profile of various APDs in relation to the potential mechanisms by which they affect appetite.

The Abrupt Withdrawal of Antiparkinsonian Drugs in Schizophrenic Patients

1974 ◽  
Vol 124 (579) ◽  
pp. 151-159 ◽  
Author(s):  
H. A. McClelland ◽  
G. Blessed ◽  
N. Ali ◽  
S. Bhate ◽  
P. A. Clarke
Keyword(s):  
Side Effects ◽  
Antipsychotic Medication ◽  
Neuroleptic Drugs ◽  
Extrapyramidal Side Effects ◽  
Abrupt Withdrawal ◽  
Schizophrenic Patients ◽  
Antiparkinsonian Drugs

Phenothiazines and other neuroleptic drugs are known to cause extrapyramidal side-effects. Consequently antiparkinsonian (AP) drugs are commonly prescribed at the same time as antipsychotic medication in order to prevent these complications. Once this medication has been started it may be continued for prolonged periods.

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