Anxiety anticholinergic drugs

A 45-year-old woman with a family history of essential tremor developed severe and persistent parkinsonism after taking kava extract for anxiety for 10 days. Her symptoms improved with anticholinergic drugs. 

In anesthesia drugs from several groups are used as premedication. Pre-anesthetic medication can decrease the anesthetic doses which otherwise would be required to induce anesthesia and so decrease the risk for adverse effects. Pre-anesthetic medication will increase the rate of induction of anesthesia and can reduce pre-operative pain and anxiety. Drugs include benzodiazepines for sedation and their muscle relaxant properties, opiates for pain relieve and anticholinergics or histamine Hi receptor antagonists against nausea and vomiting. Neuroleptics are also used as premedication for their antiemetic effects. 

The DSM-IV classifies anxiety disorders in children into four categories, namely social anxiety, over-anxious disorder, phobias and separation anxiety. Only separation anxiety, a fear of losing a loved one or a close attachment, has been reasonably well studied from the point of view of drug treatment. School phobia is perhaps the most severe form of separation anxiety and there are several trials to show that imipramine, in daily doses of up to 5mg/kg, is effective. Many patients require drug treatment for at least 6 to 8 weeks before an optimal response is achieved. Frequently, children remain symptom free after a 3M month course of treatment. In addition to the usual anticholinergic effects of imipramine, it should be noted that children are often susceptible to withdrawal symptoms such as nausea and gastrointestinal spasm. This may be reduced if the drug is slowly withdrawn over a 2-week period. 

The major adverse effects of fluoxetine confirm its stimulant profile and its relative lack of anticholinergic actions. The most frequent adverse effects, which occurred in 10-25% of patients, were nausea (25%), nervousness, insomnia, headache, tremor, anxiety, drowsiness, dry mouth, sweating, and diarrhea (10%). Most of these adverse effects occurred early in treatment and seldom led to drug withdrawal. 

Kava is an Australasian shrubby pepper (Piper methysticum). Amidst much ceremony, its crushed roots are made into an intoxicating beverage by the aboriginal people of the Molucca Islands and the Northern coast of Australia. In the west, kava is usually recommended for anxiety it appears to have sedative and extrapyramidal effects, in common with some anticholinergic and antidopaminer-gic drugs. Its sedative effects are synergistic when administered with benzodiazepines, barbiturates... 

The cannabinoids act on the cerebral cortex and have the same side effects and adverse reactions as antihistamines and anticholinergic. These include drowsiness, dry mouth, blurred vision, tachycardia, and constipation. Caimabinoids include dronabinol and nabilone. These drugs should not be administered to glaucoma patients because they dilate the pupils (mydriasis). They are contraindicated for use in patients with psychiatric disorders and also used as an appetite stimulant for patients with AIDS. Side effects include mood changes, euphoria, drowsiness, dizziness, headaches, depersonalization, nightmares, confusion, incoordination, memoiy lapse, dry mouth, orthostatic hypotension, hypertension, and tachycardia. Less common symptoms include depression, anxiety, and manic psychosis. 

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