Hallucinations anticholinergic drugs

Agitated Increased Dilated Hallucinations, hypertension and tachycardia, dry skin, mucous membranes, flushed skin with fever Anticholinergic drugs... 

The adverse effects of the anticholinergic drugs are due to their antimuscarinic effects in other systems (e.g., cycloplegia, dry mouth, urinary retention, and constipation). Confusion, delirium, and hallucinations may occur at higher doses. 

This notion resurfaced in the 1980s, when tests showed that anticholinergic drugs could both decrease the efficacy of neuroleptics in the treatment of the hallucinations and delusions and reduce the withdrawal, isolation, and lack of energy. 

A 39-year-old man who was a recreational user of alcohol and cocaine presented with agitation, hallucinations, and delirium. He had a dry flushed skin, tachycardia, dilated, minimally reactive pupils, urinary retention, and absent bowel sounds. He was treated with intravenous fluids and a sedative. There were cocaine metabolites in the urine. Reanalysis of a urine sample by thin layer chromatography confirmed the presence of the anticholinergic drug atropine. 

Anticholinergic drugs can cause vivid and sometimes exotic hallucinations and this has led to their misuse. Plants containing atropine and related substances were used in witches brews in the Middle Ages to conjure up the devil, but even synthetic tertiary amines given in eye-drops and depot plasters containing atropine (SEDA-13, 114) have caused hallucinations. Postoperative confusion... 

Much more common are such sjmptoms as confusion (13% of cases), depression (9% of cases, often requiring antidepressant drugs), and sleep disturbances (20% of cases). Vivid hallucinations are common. Psychotic sjmptoms appear to be more common when enzyme inhibitors are used or anticholinergic drugs given. Panic attacks seem to occur in some 20% of cases during the off phases of an off/on cycle (38). 

Anticholinergics are associated with many side effects including mood change, confusion, hallucinations, drowsiness, and cardiac irregularity.13,39 In addition, blurred vision, dryness of the mouth, nausea/ vomiting, constipation, and urinary retention are fairly common. Antihistamine drugs with anticholinergic properties are also used occasionally (Table 10-2). 

---