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Are Prophylactic Antiparkinson Drugs Necessary?: A Controlled Study of Procyclidine Withdrawal

Are Prophylactic Antiparkinson Drugs Necessary?: A Controlled Study of Procyclidine Withdrawal Abstract • Of 55 aftercare patients receiving long-term treatment with antipsychotic and antiparkinson (AP) drugs, 37 were switched to being given placebo, and 18 remained on a regimen of procyclidine hydrochloride. The dose of antipsychotic was kept constant. After three weeks extrapyramidal side effects (EPS) developed in 54% of those patients receiving placebo and in none of those receiving procyclidine (P <.002): Twenty-seven percent of the placebo group had EPS without akinesia, and in the same percentage akinesia developed (P =.003). We believe the risk-benefit ratio favors the routine use of AP drugs for prophylaxis and maintenance so as to avoid misdiagnosing as psychopathology, unspontaneity due to akinesia, and to reduce unreliable pill-taking due to EPS. References 1. Cohan RB, Parrish DD: Reversibility of drug induced parkinsonism . Am J Psychiatry 116:1022-1023, 1960. 2. LaPolla A, Nash LR: Treatment of phenothiazine-induced parkinsonism with Biperiden . Curr Ther Res 7:536-541, 1961. 3. Mandel W, Oliver WA: Withdrawal of maintenance antiparkinson drug in the phenothiazine-induced extrapyramidal reaction . Am J Psychiatry 118:350-351, 1961. 4. Stratas NE, Phillips RD, Walker PA, et al: A study of drug induced parkinsonism . Dis Nerv Sys 24:180-184, 1963. 5. Hanlon TF, Schoenrich C, Freinek W, et al: Perphenozine-benztropine mesylate treatment of newly admitted psychiatric patients . Psychopharmacologia 9:328-339, 1966.Crossref 6. St Jean A, Donald MW, Ban TA: Uses and abuses of antiparkinson medication . Am J Psychiatry 120:801-803, 1964. 7. St Jean A, Donald MW, Ban TA: Interchangeability of antiparkinson medication . Am J Psychiatry 120:1189-1190, 1964. 8. DiMascio A, Demirgian E: Antiparkinson drug overuse . Psychosomatics 11:596-601, 1970.Crossref 9. Mindham RHS, Gaind R, Anstee BH, et al: Comparison of amantadine, orphenadrine, and placebo in the control of phenothiazine induced parkinsonism . Psychol Med 2:406-413, 1972.Crossref 10. Klett CJ, Caffey E: Evaluating the long-term need for antiparkinson drugs by chronic schizophrenics . Arch Gen Psychiatry 26:374-379, 1972.Crossref 11. Orlov P, Kasparian G, DiMascio A, et al: Withdrawal of antiparkinson drugs . Arch Gen Psychiatry 25:410-412, 1972.Crossref 12. Chien CP, DiMascio A, Cole JO: Antiparkinson agents and depot phenothiazines . Am J Psychiatry 131:86-90, 1974. 13. Simpson GM, Angus JWS: A rating scale for extrapyramidal side effects . Acta Psychiat Scand ( (Suppl) ) 212:11-19, 1970.Crossref 14. Struve FA, Saraf KR, Arko RS, et al: Electroencephalographic correlates of oral contraceptive use in psychiatric patients . Arch Gen Psychiatry 33:741-745, 1976.Crossref 15. Rifkin A, Quitkin F, Klein DF: Akinesia-a poorly recognized druginduced extrapyramidal behavioral disorder . Arch Gen Psychiatry 32:672-674, 1975.Crossref 16. Rifkin A, Quitkin F, Klein DF: Fluphenazine decanoate, oral fluphenazine hydrochloride and placebo in the treatment of remitted schizophrenics: I. Relapse rate . Arch Gen Psychiatry 34:43-47, 1977.Crossref 17. Ananth JV, Jain RC: Benztropine psychosis . Can Psychiatr Assoc J 18:409-414, 1973. 18. Singh MM, Smith JM: Reversal of some therapeutic effects of an antipsychotic agent by an antiparkinsonism drug . J Nerv Ment Dis 157:50-58, 1973.Crossref 19. Singh MM, Kay SR: A comparative study of haloperidol and chlorpromazine in terms of clinical effects and therapeutic reversal with benztropine in schizophrenia . Psychopharmacologia 43:103-113, 1975.Crossref 20. Singh MM, Kay SR: A longitudinal comparison between two prototypic neuroleptics (haloperidol and chlorpromazine) in matched groups of schizophrenics. Non therapeutic interactions with trihexyphenidyl. Theoretical-implications for potency differences . Psychopharmacologia 43:115-123, 1975.Crossref 21. Singh MM, Kay SR: Therapeutic reversal with benztropine in schizophrenics . J Nerv Ment Dis 160:258-266, 1975.Crossref 22. Kane J, Rifkin A, Quitkin F, et al: Antipsychotic drug blood levels and clinical outcome , in Klein DF, Gittleman-Klein K (eds): Progress in Psychiatric Drug Treatment , vol 2. New York, Brunner Mazel, 1976. 23. Van Putten T: Why do schizophrenic patients refuse to take their drugs? Arch Gen Psychiatry 31:67-72, 1975.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

Are Prophylactic Antiparkinson Drugs Necessary?: A Controlled Study of Procyclidine Withdrawal

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Publisher
American Medical Association
Copyright
Copyright © 1978 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1978.01770280093010
Publisher site
See Article on Publisher Site

Abstract

Abstract • Of 55 aftercare patients receiving long-term treatment with antipsychotic and antiparkinson (AP) drugs, 37 were switched to being given placebo, and 18 remained on a regimen of procyclidine hydrochloride. The dose of antipsychotic was kept constant. After three weeks extrapyramidal side effects (EPS) developed in 54% of those patients receiving placebo and in none of those receiving procyclidine (P <.002): Twenty-seven percent of the placebo group had EPS without akinesia, and in the same percentage akinesia developed (P =.003). We believe the risk-benefit ratio favors the routine use of AP drugs for prophylaxis and maintenance so as to avoid misdiagnosing as psychopathology, unspontaneity due to akinesia, and to reduce unreliable pill-taking due to EPS. References 1. Cohan RB, Parrish DD: Reversibility of drug induced parkinsonism . Am J Psychiatry 116:1022-1023, 1960. 2. LaPolla A, Nash LR: Treatment of phenothiazine-induced parkinsonism with Biperiden . Curr Ther Res 7:536-541, 1961. 3. Mandel W, Oliver WA: Withdrawal of maintenance antiparkinson drug in the phenothiazine-induced extrapyramidal reaction . Am J Psychiatry 118:350-351, 1961. 4. Stratas NE, Phillips RD, Walker PA, et al: A study of drug induced parkinsonism . Dis Nerv Sys 24:180-184, 1963. 5. Hanlon TF, Schoenrich C, Freinek W, et al: Perphenozine-benztropine mesylate treatment of newly admitted psychiatric patients . Psychopharmacologia 9:328-339, 1966.Crossref 6. St Jean A, Donald MW, Ban TA: Uses and abuses of antiparkinson medication . Am J Psychiatry 120:801-803, 1964. 7. St Jean A, Donald MW, Ban TA: Interchangeability of antiparkinson medication . Am J Psychiatry 120:1189-1190, 1964. 8. DiMascio A, Demirgian E: Antiparkinson drug overuse . Psychosomatics 11:596-601, 1970.Crossref 9. Mindham RHS, Gaind R, Anstee BH, et al: Comparison of amantadine, orphenadrine, and placebo in the control of phenothiazine induced parkinsonism . Psychol Med 2:406-413, 1972.Crossref 10. Klett CJ, Caffey E: Evaluating the long-term need for antiparkinson drugs by chronic schizophrenics . Arch Gen Psychiatry 26:374-379, 1972.Crossref 11. Orlov P, Kasparian G, DiMascio A, et al: Withdrawal of antiparkinson drugs . Arch Gen Psychiatry 25:410-412, 1972.Crossref 12. Chien CP, DiMascio A, Cole JO: Antiparkinson agents and depot phenothiazines . Am J Psychiatry 131:86-90, 1974. 13. Simpson GM, Angus JWS: A rating scale for extrapyramidal side effects . Acta Psychiat Scand ( (Suppl) ) 212:11-19, 1970.Crossref 14. Struve FA, Saraf KR, Arko RS, et al: Electroencephalographic correlates of oral contraceptive use in psychiatric patients . Arch Gen Psychiatry 33:741-745, 1976.Crossref 15. Rifkin A, Quitkin F, Klein DF: Akinesia-a poorly recognized druginduced extrapyramidal behavioral disorder . Arch Gen Psychiatry 32:672-674, 1975.Crossref 16. Rifkin A, Quitkin F, Klein DF: Fluphenazine decanoate, oral fluphenazine hydrochloride and placebo in the treatment of remitted schizophrenics: I. Relapse rate . Arch Gen Psychiatry 34:43-47, 1977.Crossref 17. Ananth JV, Jain RC: Benztropine psychosis . Can Psychiatr Assoc J 18:409-414, 1973. 18. Singh MM, Smith JM: Reversal of some therapeutic effects of an antipsychotic agent by an antiparkinsonism drug . J Nerv Ment Dis 157:50-58, 1973.Crossref 19. Singh MM, Kay SR: A comparative study of haloperidol and chlorpromazine in terms of clinical effects and therapeutic reversal with benztropine in schizophrenia . Psychopharmacologia 43:103-113, 1975.Crossref 20. Singh MM, Kay SR: A longitudinal comparison between two prototypic neuroleptics (haloperidol and chlorpromazine) in matched groups of schizophrenics. Non therapeutic interactions with trihexyphenidyl. Theoretical-implications for potency differences . Psychopharmacologia 43:115-123, 1975.Crossref 21. Singh MM, Kay SR: Therapeutic reversal with benztropine in schizophrenics . J Nerv Ment Dis 160:258-266, 1975.Crossref 22. Kane J, Rifkin A, Quitkin F, et al: Antipsychotic drug blood levels and clinical outcome , in Klein DF, Gittleman-Klein K (eds): Progress in Psychiatric Drug Treatment , vol 2. New York, Brunner Mazel, 1976. 23. Van Putten T: Why do schizophrenic patients refuse to take their drugs? Arch Gen Psychiatry 31:67-72, 1975.Crossref

Journal

Archives of General PsychiatryAmerican Medical Association

Published: Apr 1, 1978

References

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