Caradoc-Davies G, Menkes D B, Clarkson H O, Mullen P E
Aust N Z J Psychiatry. 1986 Jun;20(2):225-32. doi: 10.3109/00048678609161335.
Studies on the withdrawal of anticholinergics from patients on antipsychotics have produced conflicting results. This 12-week study employed a double-blind crossover design on 39 adult in-patients selected from a total hospital population of 620. The Colombia Scale was used to determine extrapyramidal side effects (EPS). All patients were stabilised prior to the study on benztropine mesylate 2 mg b.i.d., and gradual withdrawal was employed. Benztropine withdrawal produced a significant increase in overall EPS scores. Ten patients (26%) required reinstatement of benztropine while on placebo. Sialorrhoea, rigidity and postural instability were the most prominent changes. Neither age, sex, nor diagnosis were significantly predictive of EPS. Depot medications and doses greater than 1000 mg/day chlorpromazine-equivalent were related to significant EPS increase. The intrinsic anticholinergic properties of the antipsychotics themselves and concomitant medications, such as antidepressants, appeared protective against development of EPS. Most patients on a combination of antipsychotics and anticholinergics can safely be withdrawn from the latter.
关于从使用抗精神病药物的患者中停用抗胆碱能药物的研究结果相互矛盾。这项为期12周的研究对从620名住院患者中挑选出的39名成年住院患者采用了双盲交叉设计。使用哥伦比亚量表来确定锥体外系副作用（EPS）。在研究前，所有患者均使用甲磺酸苯扎托品2毫克，每日两次进行稳定治疗，并采用逐渐撤药的方法。停用苯扎托品后，总体EPS评分显著增加。10名患者（26%）在服用安慰剂时需要重新使用苯扎托品。流涎、僵硬和姿势不稳是最显著的变化。年龄、性别和诊断均不能显著预测EPS。长效药物以及氯丙嗪等效剂量大于1000毫克/天与EPS显著增加有关。抗精神病药物本身的内在抗胆碱能特性以及抗抑郁药等联合用药似乎对EPS的发展具有保护作用。大多数同时使用抗精神病药物和抗胆碱能药物的患者可以安全地停用后者。
