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Case report
Anticholinergic medications even in therapeutic range can cause recurrence of psychosis
  1. Soumitra Das1,
  2. Seshadri Sekhar Chatterjee2 and
  3. Barikar Chandrappa Malathesh3
  1. 1 Psychiatry, NorthWestern Mental Health, Melbourne, Victoria, Australia
  2. 2 Psychiatry, Diamond Harbour Medical College, Diamond Harbour, India
  3. 3 Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India
  1. Correspondence to Dr Seshadri Sekhar Chatterjee; drsschatterjee{at}gmail.com

Abstract

Anticholinergic drugs are commonly used in psychiatry to attenuate antipsychotic induced extrapyramidal syndrome (EPS). Psychosis as a side effect is generally explained under the rubric of anticholinergic toxicity or induced delirium. Anticholinergic induced worsening of psychosis in patients with normal cognition is extremely rare in literature. Here, we arepresenting a case of young female who was prescribed with multiple anticholinergics to reduce EPS, and each time had worsening of psychosis with intact cognition. We then discussed the possible neurobiological explanation with special reference to muscarinic hypothesis of schizophrenia.

  • psychopharmacology
  • biological psychiatry
  • schizophrenia
  • neuropsychiatry
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/gpsych-2020-100235

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    Footnotes

    • Twitter @SeshadriSSC

    • Contributors SD: design, clinical data extraction and drafting of the study. SSC: conceptualisation, drafting, writing the manuscript, editing and intellectual content. BCM: editing, searching for data and writing.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.