[Central anticholinergic intoxication syndrome. A contribution to the differential diagnosis of exogenous psychoses].
A withdrawal syndrome in a 50-year-old alcoholic subsided within 5 days in response to treatment with doxepin (150 mg/d). But 2 days later he developed auditory hallucinations which were interpreted as alcohol hallucinations, for which he was additionally given haloperidol, 15 mg/d. He then developed early dyskinesia which was treated with 5 mg biperiden i.v. followed by twice 2 mg/d by mouth, while doxepin and haloperidol were continued. 5 days after detoxification there occurred, under this combination of drugs which included two with marked anticholinergic action, an anticholinergic intoxication syndrome characterized by restlessness, optical hallucinations, dysarthritic speech, mydriasis, urinary retention, fever, tachycardia and red, dry skin. After all previous drugs had been discontinued and clomethiazole started, the intoxication syndrome began to regress within 3 days. The case demonstrates the need to consider a central anticholinergic syndrome, which could end fatally, as a possible cause of otherwise unexplained delirium.
Klinik für Allgemeine Psychiatrie, Rheinische Landes- und Hochschulklinik Essen.
O
O
Kastrup
G
G
Eikmeier
M
M
Gastpar
D017109:Akathisia, Drug-Induced; D001712:Biperiden / Q000009:adverse effects* / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004316:Doxepin / Q000009:adverse effects* / Q000627:therapeutic use; D004401:Dysarthria / Q000139:chemically induced; D004409:Dyskinesia, Drug-Induced / Q000188:drug therapy; D000431:Ethanol / Q000009:adverse effects*; D005334:Fever / Q000139:chemically induced; D006212:Hallucinations / Q000139:chemically induced / Q000188:drug therapy; D006220:Haloperidol / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D015878:Mydriasis / Q000139:chemically induced; D012867:Skin / Q000187:drug effects; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy*; D013610:Tachycardia / Q000139:chemically induced; D016055:Urinary Retention / Q000139:chemically induced
D001712:Biperiden; D004316:Doxepin; D000431:Ethanol; D006220:Haloperidol
Zentral-anticholinerges Intoxikationssyndrom. Ein Beitrag zur Differentialdiagnose exogener Pychosen.