抗胆碱能抗帕金森病药物所致的谵妄与刻板动作。

Delirium and stereotypy from anticholinergic antiparkinson drugs.

Kulik A V, Wilbur R

Prog Neuropsychopharmacol Biol Psychiatry. 1982;6(1):75-82. doi: 10.1016/s0364-7722(82)80110-0.

Abstract

This report describes two cases of psychotic syndrome from benztropine (Cogentin), which was used to treat haloperidol-induced extrapyramidal side effects. The patients' symptomatology meets DSM III criteria for delirium. Both patients displayed repetitive motor automatisms (stereotypy). 2. Symptomatology appeared one-to-two days after the start of benztropine 2 mg b.i.d. and subsided one-to-several days after benztropine was stopped. Treatment consisted of administration of sedative hypnotic drugs. 3. The literature on anticholinergic-induced psychotic syndromes is surveyed. Particular attention is drawn to the occurrence of stereotypy. 4. It is proposed, on the basis of a review of animal and clinical data, that stereotypies in delirious patients are related to muscarinic blockade in the central nervous system. This model is used to explain repetitive motor automatisms which are seen in Alzheimer's disease. 5. The paper concludes with brief guidelines for the management of anticholinergic delirium.

摘要

本报告描述了两例因使用苯海索（安坦）治疗氟哌啶醇所致锥体外系副作用而出现的精神综合征病例。患者的症状符合《精神疾病诊断与统计手册》第三版中谵妄的标准。两名患者均表现出重复性运动自动症（刻板动作）。2. 症状在开始每日两次服用2毫克苯海索后1至2天出现，并在停用苯海索后1至数天消退。治疗包括给予镇静催眠药物。3. 对有关抗胆碱能药物所致精神综合征的文献进行了综述。特别关注了刻板动作的发生情况。4. 根据对动物和临床数据的回顾，提出谵妄患者的刻板动作与中枢神经系统中的毒蕈碱阻断有关。该模型用于解释在阿尔茨海默病中所见的重复性运动自动症。5. 本文最后给出了抗胆碱能谵妄管理的简要指南。