Hallucination anticholinergics

The Class I agents have many similar side effects and toxicities. The anticholinergic side effects include dry mouth, constipation, and urinary hesitancy and retention. Common gastrointestinal (GI) side effects include nausea, vomiting, diarrhea, and anorexia. Cardiovascular adverse effects are hypotension, tachycardia, arrhythmias, and myocardial depression, especially in patients with congestive heart failure. Common central nervous system (CNS) side effects are headache, dizziness, mental confusion, hallucinations, CNS stimulation, paraesthesias, and convulsions. 

In addition, 19% to 30% of patients given anticholinergics develop depression, confusion, delusions, or hallucinations. 

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

Although atropine and scopolamine share many properties, an important difference is the easier entry of scopolamine into the CNS. Typical doses of atropine (0.2-2 mg) have minimal central effects, while larger doses can produce a constellation of responses collectively termed the central anticholinergic syndrome. At intermediate doses (2-10 mg), memory and concentration may be impaired, and the patient may be drowsy. If doses of 10 mg or more are used, the patient may exhibit confusion, excitement, hallucinations, ataxia, asyn-ergia, and possibly coma. 

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. 

Amantadine was originally introduced as an antiviral compound (see Chapter 50), but it is modestly effective in treating symptoms of parkinsonism. It is useful in the early stages of parkinsonism or as an adjunct to levodopa therapy. Its mechanism of action in parkinsonism is not clear, but amantadine may affect dopamine release and reuptake. Additional sites of action may include antagonism at muscarinic and A-methyl-D-aspartate (NMDA) receptors. Adverse effects include nausea, dizziness, insomnia, confusion, hallucinations, ankle edema, and livedo reticularis. Amantadine and the anticholinergics may exert additive effects on mental functioning. 

Some of the expected changes with age, such as the reduction in cholinergic neurons or the presence of Alzheimer s dementia, may accentuate the anticholinergic effects of many antipsychotics and antidepressants. Thus, elderly patients have increased sensitivity to these properties, often resulting in a central anticholinergic syndrome (267). This condition is characterized by the loss of immediate memory, confusion, disorientation, and florid visual hallucinations, at times superimposed on other psychoses, such as schizophrenia or psychotic depression. 

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. 

As in dream psychosis, the hallucinations and delusions of schizophrenic psychosis are referred to as positive symptoms, implying an increase in excitability of the upper brain circuits mediating perception and its associated cognition. Anticholinergics can precipitate... 

Dronabinol (Marinof) [C-ll] [Anriemeric, Appetite Stimulant/ Antivertigo] Uses N/V associated w/ CA chemo appetite stimulation Action Antiemetic 4- V center in the medulla Dose Adults Peds. Antiemetic 5-15 mg/m2/dose q4-6h PRN Adults. Appetite stimulant 2.5 mg PO before lunch dinner max 20 mg/d Caution [C, ] Contra Hx schizophrenia, sesame oil hypersensitivity Disp Caps SE Drowsiness, dizziness, anxiety, mood change, hallucinations, depersonalization, orthostatic 4- BP, tach Interactions T Effects W/ anticholinergics, CNS depressants, EtOH 4- effects of theophylline EMS Use caution w/ sympathomimetics, can T hypertension and tach use caution w/ anticholinergics and antihistamines, can T tach concurrent EtOH use can T CNS depression this is a principal psychoactive substance present in marijuana OD May cause extreme psychiatric effects (anxiety, mood changes and depersonalization) keep pt in a quiet environment and provide reassurance activated charcoal may be effective... 

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). 

Many different classes of drugs can produce hallucinations when given in toxic doses (e.g. the anticholinergics, such as atropine and scopolamine), but such symptoms are generally associated with confusion and lack of sensory clarity. As such, hallucinations are a component of a toxic psychosis. 

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