抗Choilne系 및 抗精神病 藥物에 依한 知覺認知障碍

PERCEPTUAL COGNITIVE CHANGE FOLLOWING ANTICHOLINERGIC AND ANTIPSYCHOTIC AGENTS

Four cases of perceptual-cognitive disorder following the use of anticholinergic and antipsychotic drugs were reported. The first case was an avoidant personality disorder who had been given 2mg of Benztropine in a daily single dosis for the control of dystonia from Haloperidol. On the second day of Benztropine medication, typical perceptual-cognitive disorder was developed abruptly. The second case was a patient with peptic ulcer who had used 30mg of Propanthiline bromide in daily devided doses into three times. The perceptualcognitive disorder appeared on the fourth day of medication. The third case was an obsessive compulsive patient who had been given 3mg of Haloperidol. On the fourth day after increasing the dosis from 3mg to 4 .5mg, the perceptualcognitive symptom was developed. Decrease of the dosis from 4 .5mg to 3mg resulted in disappearance of the symptom. Fluphenazine decanoate 0.3cc(7.5mg) was injected to the same patient intramusculary after with drawal of Haloperidol. On the third day of Fluphenazine injection, the same perceptual-cognitive symptom could be noticed again. Decrease of the dosis of Fluphenazine to 0 .15cc in the next shot could result in symtom-free state. The fourth case was a recovered schizophrenic who had revealed perceptual- cognitive symptom following the use of 5mg of Thiothixene. The same symptom appeared 0 .2cc(5mg)of Fluphenazine decanoate. With drawal of Thiothixene and decrease of the dosis of Fluphenazine resulted in symptom disappearance. A brup t onset of intensified visual stimuli in flux or micropsia and cognitive confusion without delirium was the main clinical picture. These symptoms were developed on the second, third or fourth day after the use or increase of the drugs, and continued several hours and, as a rule terminated by sleeping. This experience was repeated daily in the afternoon during medication, and disappeared by with drawal of the drugs or by decrease of the dosis. The aforementioned symptoms reappeared by remedication or reincrease of the drugs in each case. Exact mechanism of the perceptual-cognitive disorders remain unknown, but anticholinergic activity of the drugs can be suspected as a possible causative factor. It was also suggested that there is a few susceptible person to perceptual cognitive side reaction to anticholinergics, and in such a case, symptom appearance seemed to be dose-related.