Cocaine as a risk factor for neuroleptic-induced acute dystonia.
BACKGROUND
A prospective study was conducted to test the hypothesis that cocaine use is a risk factor for neuroleptic-induced acute dystonia (NIAD).


METHODS
The study sample consisted of a high-risk group for NIAD, males aged 17-45 years who had received high-potency neuroleptics within 24 hours of admission and had not used neuroleptics in the month prior to admission. Patients were excluded if they suffered from a neurodegenerative disorder or were exposed to anticholinergics, benzodiazepines, promethazine, carbamazepine, phenytoin, or levodopa during the study. Twenty-nine patients--9 cocaine users and 20 nonusers--entered the study, which lasted 2 years. Patients were followed for 7 days.


RESULTS
Cocaine-using psychiatric patients developed significantly more NIAD than did nonusers (relative risk = 4.4, 95% CI = 1.4 to 13.9).


CONCLUSIONS
Cocaine use is a major risk factor for NIAD and should be added to the list of well-known risk factors. The authors strongly suggest that cocaine-using psychiatric patients who are started on a regimen of neuroleptics should also be administered an anticholinergic for at least 7 days to prevent NIAD.
van Harten
P N
PN
Psychiatric Hospital (Dr. D. R. Capriles Clinic), Curaçao, The Netherlands Antilles.
van Trier
J C
JC
Horwitz
E H
EH
Matroos
G E
GE
Hoek
H W
HW
D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy / Q000453:epidemiology; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D019970:Cocaine-Related Disorders / Q000453:epidemiology*; D015897:Comorbidity; D004359:Drug Therapy, Combination; D004421:Dystonia / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D009427:Netherlands Antilles / Q000453:epidemiology; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000453:epidemiology; D012307:Risk Factors; D012559:Schizophrenia / Q000188:drug therapy / Q000453:epidemiology
D014150:Antipsychotic Agents; D018680:Cholinergic Antagonists