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The Withdrawal of Benztropine Mesylate in Chronic Schizophrenic Patients

Published online by Cambridge University Press:  29 January 2018

Linda A. Baker ,
L. Y. Cheng  and
I. B. Amara
Linda A. Baker
Affiliation:
Department of Psychology, Queen's University, Kingston, Ontario, Canada
L. Y. Cheng
Affiliation:
Department of Psychiatry, Queen's University, Kingston Psychiatric Hospital, Kingston, Ontario, Canada
I. B. Amara
Affiliation:
Kingston Psychiatric Hospital, Department of Psychiatry, Queen's University
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Summary

In this double-blind, four-week study, 28 chronic schizophrenic patients receiving neuroleptic medication plus the antiparkinsonian drug, benztropine mesylate, were either switched to placebo or maintained on benztropine. Patients withdrawn from benztropine reliably increased their overall scores on the Wechsler Memory Scale in comparison with the drug group. Sub-test scores suggest that deficits in attention and concentration were induced by treatment with benztropine. Psychotio decompensation appeared to develop simultaneously with extrapyramidal symptoms (EPS) in some patients, but only 14.2 per cent of the placebo group experienced extrapyramidal symptoms severe enough to require resumption of benztropine therapy. It is suggested that antiparkinsonian agents should be prescribed only if and when EPS occur.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 143 , Issue 6 , December 1983 , pp. 584 - 590
Copyright
Copyright © 1983 The Royal College of Psychiatrists 

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References

Ananth, J. V. & Jain, R. C. (1973) Benztropine psychosis. Canadian Psychiatric Association Journal, 18, 409–14.CrossRefGoogle ScholarPubMed
Aquilonius, S.-M. (1978) Physostigmine in the treatment of drug overdose. In Cholinergic Mechanisms and Psychopharmacy (ed. Jenden, D. J.). New York: Plenum.Google Scholar
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J. & Erbaugh, J. (1961) An inventory for measuring depression. Archives of General Psychiatry, 4, 53–63.CrossRefGoogle ScholarPubMed
Blum, R. A., Livingston, P. B. & Shader, R. I. (1969) Changes in cognition, attention and language in acute schizophrenia. Diseases of the Nervous System, 30, 31–6.Google ScholarPubMed
Caroli, F., Littre-Poirier, M.-F., Ginestet, D. & Deniker, P. (1975) Essai d'interruption des antiparkinsoniens dans les traitements neuroleptiques au long cours. L'Enêphale, 1, 69–74.Google Scholar
Carpenter, W. T. (1973) Flexible system for the diagnosis of schizophrenia: Report from the WHO International Pilot Study of Schizophrenia. Science, 182, 1275–8.CrossRefGoogle ScholarPubMed
Cheng, L. Y., Baker, L. & Amara, I. B. (1981) Neuroleptics, antiparkinsonian medication and schizophrenia (letter to the editor). American Journal of Psychiatry, 138, 1390.Google Scholar
Chien, C.-P., DiMascio, A. & Cole, J. O. (1974) Antiparkinsonian agents and depot phenothiazine. American Journal of Psychiatry, 131, 86–90.CrossRefGoogle ScholarPubMed
Davies, R. K., Tucker, G. J., Harrow, M. & Detre, T. P. (1971) Confusional episodes and antidepressant medication. American Journal of Psychiatry, 128, 127–31.CrossRefGoogle ScholarPubMed
Davis, L. C. Jr. & Swenson, W. M. (1970) Factor analysis of the Wechsler Memory Scale. Journal of Consulting and Clinical Psychology, 35, 430.CrossRefGoogle Scholar
DiMascio, A. & Demirgian, E. (1970) Antiparkinson drug overuse. Psychosomatics, 11, 596–601.CrossRefGoogle ScholarPubMed
Drachman, D. A. (1977) Memory and cognitive function in man: Does the cholinergic system have a specific role? Neurology, 27, 783–90.CrossRefGoogle ScholarPubMed
Drachman, D. A. & Leavitt, J. (1974) Human memory and the cholinergic system. Archives of Neurology, 30, 113–21.CrossRefGoogle ScholarPubMed
Dunlap, J. C. & Miller, W. C. (1969) Toxic psychosis following the use of benztropine methanesulfonate (Cogentin). Journal of the South Carolina Medical Association, 65, 203–4.Google Scholar
Duvoisin, R. C. & Katz, R. (1968) Reversal of central anticholinergic syndrome in man by physostigmine. JAMA, 206, 1963–5.CrossRefGoogle Scholar
El-Yousef, M. K., Davis, J. M., Janowsky, D. S. & Fann, W. E. (1972) Central atropine-like toxicity in combined psychotropic drug administration. Journal of the Tennessee Medical Association, 65, 719.Google ScholarPubMed
El-Yousef, M. K., Janowsky, D. S., Davis, J. M. & Sekerke, H. J. (1973) Reversal of antiparkinsonian drug toxicity by physostigmine: A controlled study. American Journal of Psychiatry, 130, 141–5.CrossRefGoogle ScholarPubMed
Forrer, G. R. & Miller, J. J. (1958) Atropine coma: A somatic therapy in psychiatry. American Journal of Psychiatry, 115, 455–8.CrossRefGoogle Scholar
Granacher, R. P. & Baldessarini, R. J. (1975) Physostigmine: Its use in acute anticholinergic syndrome with antidepressant and antiparkinson drugs. Archives of General Psychiatry, 32, 375–80.CrossRefGoogle ScholarPubMed
Honigfeld, G., Gillis, R. D. & Klett, C. J. (1966) NOSIE-30: A treatment-sensitive ward behaviour scale. Psychological Reports, 19, 180–2.CrossRefGoogle Scholar
Innes, I. R. & Nickerson, M. (1975) Atropine, scopolamine, and related antimuscarinic drugs. In The Pharmacologic Basis of Therapeutics, 5th ed. (eds. Goodman, L. S. and Gilman, A.). New York: Macmillan.Google Scholar
Kalman, T. & Warner, G. M. (1978) Protracted vomiting following abrupt cessation of psychotropics: A case report. Canadian Psychiatric Association Journal, 23, 163–5.CrossRefGoogle ScholarPubMed
Kear-Colwell, J. J. (1973) The structure of the Wechsler Memory Scale and its relationship to “brain damage.” British Journal of Social and Clinical Psychology, 12, 384–92.CrossRefGoogle ScholarPubMed
Klett, C. J. & Caffey, E. (1972) Evaluating the long-term need for antiparkinson drugs by chronic schizophrenics. Archives of General Psychiatry, 26, 374–9.CrossRefGoogle ScholarPubMed
Lezak, M. D. (1977) Neuropsychological Assessment. New York: Oxford University Press.Google Scholar
Manos, N. (1981) Dr. Manos replies (letter to the editor). American Journal of Psychiatry, 138, 1390.CrossRefGoogle Scholar
Manos, N., Gkiouzepas, J. & Logothetis, J. (1981) The need for continuous use of antiparkinsonian medication with chronic schizophrenic patients receiving long-term neuroleptic therapy. American Journal of Psychiatry, 138, 184–8.Google ScholarPubMed
McGhie, A., Chapman, J. & Lawson, J. S. (1965) The effects of distraction on schizophrenic performance: (I) Perception and immediate memory. British Journal of Psychiatry, 111, 383–90.Google Scholar
Mindham, R. H. S., Gaind, R., Anstee, B. H. & Rimmer, L. (1972) Comparison of amantadine, orphenadrine, and placebo in the control of phenothiazine-induced Parkinsonism. Psychological Medicine, 2, 406–13.CrossRefGoogle ScholarPubMed
Oltmanns, T. F., Ohayon, J. & Neale, J. N. (1978) The effect of antipsychotic medication and diagnostic criteria on distractibility in schizophrenia. In The Nature of Schizophrenia: New Approaches to Research and Treatment (eds. Wynne, L. C., Cromwell, R. L. and Matthysse, S.). New York: John Wiley.Google Scholar
Ostfeld, A. M. & Aruguete, A. (1962) Central nervous system effects of hyoscine in man. Journal of Pharmacology and Experimental Therapeutics, 137, 133–9.Google ScholarPubMed
Overall, J. E. & Gorham, D. R. (1962) The Brief Psychiatric Rating Scale. Psychological Reports, 10, 799–812.CrossRefGoogle Scholar
Pecknold, J. C., Ananth, J. V., Ban, T. A. & Lehmann, H. E. (1971) Lack of indication for use of antiparkinson medication. Diseases of the Nervous System, 32, 538–41.Google ScholarPubMed
Potamianos, G. & Kellett, J. M. (1982) Anti-cholinergic drugs and memory: The effects of benzhexol on memory in a group of geriatric patients. British Journal of Psychiatry, 140, 470–2.CrossRefGoogle Scholar
Safer, D. G. & Allen, R. P. (1971) The central effects of scopolamine in man. Biological Psychiatry, 3, 347–55.Google ScholarPubMed
Simpson, G. M. & Angus, J. W. (1970) A rating scale for extra-pyramidal side effects. Acta Psychiatrica Scandinavica, Suppl. 212, 11–19.CrossRefGoogle Scholar
Singh, M. M. & Kay, S. R. (1974) Therapeutic antagonism between neuroleptics and anticholinergic antiparkinsonism agents in schizophrenia. Journal of the Bronx State Hospital, 2, 8–20.Google Scholar
Singh, M. M. & Kay, S. R. (1975) Therapeutic reversal with benztropine in schizophrenics. Journal of Nervous and Menial Disease, 169, 258–65.Google Scholar
Singh, M. M. & Smith, J. M. (1973) Reversal of some therapeutic effects of an antipsychotic agent by an antiparkinsonism drug. Journal of Nervous and Mental Disease, 157, 50–8.CrossRefGoogle ScholarPubMed
Snyder, S., Greenberg, D. & Yamamura, H. I. (1974) Antischizophrenic drugs and brain cholinergic receptors. Archives of General Psychiatry, 31, 58–61.CrossRefGoogle ScholarPubMed
Spielberger, C. D., Gorsuch, R. L. & Lushene, R. E. (1970) Manual for the State-Trait Anxiety Inventory. Palo Alto: Consulting Psychologists Press.Google Scholar
Spohn, H. E., Lacoursiere, R. B., Thompson, K. & Coyne, L. (1978) The effects of antipsychotic drug treatment on attention and information processing in chronic schizophrenics. In The Nature of Schizophrenia: New Approaches to Research and Treatment (eds. Wynne, L. C., Cromwell, R. L. and Matthysse, S.). New York: John Wiley & Sons.Google Scholar
Swett, C. Jr., Cole, J. O., Shapiro, S. & Slone, D. (1977) Extrapyramidal side effects in chlorpromazine recipients. Archives of General Psychiatry, 34, 942–3.CrossRefGoogle ScholarPubMed
Telford, R. & Worrall, E. P. (1978) Cognitive functions in manic-depressives: Effects of lithium and physostigmine. British Journal of Psychiatry, 133, 424–8.CrossRefGoogle ScholarPubMed
Van Kammen, D. P. (1981) Neuroleptics, antiparkinsonian medication, and schizophrenia (letter to the editor). American Journal of Psychiatry, 138, 1389–90.CrossRefGoogle Scholar
Wechsler, D. & Stone, C. P. (1945) Manual for the Wechsler Memory Scale. New York: The Psychological Corporation.Google Scholar
Ziemba, T., Meltzer, H. Y. & Davis, J. M. (1978) Do anticholinergics antagonize antipsychotic drug action? Schizophrenia Bulletin, 4, 7–12.CrossRefGoogle ScholarPubMed
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