Noncompliance with antiparkinsonian medications in neuroleptic-treated schizophrenic patients: three cases of an unreported phenomenon.

BACKGROUND

Depression is commonly associated with the longitudinal course of schizophrenia. Several etiologies for this problem have been proposed but, to our knowledge, noncompliance with antiparkinsonian medications has not been considered.

METHOD

Case histories of two patients who were noncompliant and one who threatened noncompliance with antiparkinsonian medications are presented. All three patients were diagnosed with schizophrenia by DSM-III-R criteria and had been clinically stable for long periods.

RESULTS

All three patients became depressed when their adjunctive benztropine was stopped, and their depressions remitted when their benztropine was reinstated.

CONCLUSION

Noncompliance with antiparkinsonian medications may be associated with a reversible depression in patients receiving maintenance neuroleptics for schizophrenia. Since this is a newly described phenomenon, the scope of the problem is not known; however, it may contribute to the wide prevalence of depressive symptoms in schizophrenia. Clinical measures to facilitate detection of such noncompliance are discussed.