Hallucinations atropine

The answers arc 488-d, 489-h. (Katzang, pp 108-112, 1020.) Atropine blocks muscarinic cholinergic transmission in the brain and in the autonomic nervous system. The result is dry mouth, thirst, dry and hot skin, tachycardia, urinary retention, ataxia, restlessness, excitement, and hallucinations, followed by stupor, delirium, respiratory depression, coma, and death. 

Therapeutic doses of scopolamine produce CNS depression, characterized by drowsiness, amnesia, and dreamless sleep (Brown and Taylor 1996). It reduces arousal and increases the effort required to awaken (Parrott 1987). Higher therapeutic doses of atropine cause central excitation, characterized by restlessness, irritability, confusion, disorientation, hallucinations, and delirium. Larger doses produce central depression, paralysis, coma, and death by respiratory failure and cardiovascular collapse. 

Other examples cited by Goodman include the poisoning of 200 French soldiers by Chinese reformers in Hanoi on 27 June 1908, all of whom recovered. One of the intoxicated soldiers saw ants on his bed, a second fled to a tree to escape from a hallucinated tiger and a third took aim at birds in the sky. Another incident was the abortive attempt by Soviet agents in 1959 to poison the staff of Radio Free Europe in Munich by putting atropine in saltshakers in the cafeteria. A double agent foiled this effort. 

Central Motor restlessness, progressing to maniacal agitation, psychic disturbances, disorientation, and hallucinations. Elderly subjects are more sensitive to such central effects, in this context, the diversity of drugs producing atropine-like side effects should be borne in mind e.g., tricyclic antidepressants, neuroleptics, antihistamines, antiarrhythmics, antiparkinsonian agents. 

Atropine-like effects - dry mouth, dilated pupils, confusion, hallucinations, memory lose Solanaceae family -jimsonweed, henbane, deadly nightshade (Atropa belladonna), angles trumpet (atropine and scopolamine) Clinical effects of many of the plants recognized since ancient times. Deaths are rare but children vulnerable. Hallucinations from muscarine and psilocybin... 

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. 

Atropine like drugs cause several side effects such as dry mouth, blurred vision, urinary retention, mental confusion, hallucinations etc. 

In the doses usually used, atropine has minimal stimulant effects on the CNS, especially the parasympathetic medullary centers, and a slower, longer-lasting sedative effect on the brain. Scopolamine has more marked central effects, producing drowsiness when given in recommended dosages and amnesia in sensitive individuals. In toxic doses, scopolamine, and to a lesser degree atropine, can cause excitement, agitation, hallucinations, and coma. 

At higher concentrations, atropine causes block of all parasympathetic functions. However, atropine is a remarkably safe drug in adults. Atropine poisoning has occurred as a result of attempted suicide, but most cases are due to attempts to induce hallucinations. 

Jimson weed contains the naturally occurring compounds atropine and scopolamine, which can interfere with the activity of the nervous system by blocking the action of a key chemical known as acetylcholine. This interference can produce hallucinations. Ingestion of the plant can also cause dilation of the pupils, blurred vision, rapid heart beat, reduction of salivation, as well as sedation and all of these effects are potentially useful in the practice of medicine. Consequently, by the early 1800s people the world over were buying Jimson weed from their local apothecaries. This included the citizens of Mecca. 

The atropine series contains a number of very closely allied alkaloids of which the chief are atropine, hyoscyamine, and hyoscine (also called scopolamine). They are found in the roots and leaves of many plants of the Solanaceae, notably belladonna (Atropa belladonna), henbane (Hyoscyamus niger), the thorn apple or jimson weed (Datura stramonium), and some members of the Duboisia and Scopolia genera. These plants were used during the Middle Ages as sorcerer s drugs and have been smoked, chewed, or imbibed in the form of decoctions by primitive people for the hallucinations and frenzy they produce (Figure 14.1). 

At higher concentrations, atropine causes block of all parasympathetic functions. However, atropine is a remarkably safe drug in adults. Atropine poisoning has occurred as a result of attempted suicide, but most cases are due to attempts to induce hallucinations. Poisoned individuals manifest dry mouth, mydriasis, tachycardia, hot and flushed skin, agitation, and delirium for as long as a week. Body temperature is frequently elevated. These effects are memorialized in the adage, "dry as a bone, blind as a bat, red as a beet, mad as a hatter."... 

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. 

Intoxications with higher concentrations will cause tachycardia, mydriasis, CNS excitations and hallucinations, coma and ultimately death [42], Incorporation of atropine (more correctly S-hyoscyamine) is the predominant reason for TA intoxication after ingestion of Datura plants. 

Incidental and accidental intake of atropine and scopolamine, which are the main tropane alkaloids in plants of the solanecae family, may provoke poisoning of man and livestock [11,13-15, 55, 57,119-122] causing agitation, aggression, hallucinations, dry mouth and skin, mydriasis, loss of consciousness followed by coma combined with tachycardia, hypotension, and hyperthermia [57, 121], A detailed statistical analysis of paediatric plant exposures in Germany within the years 1998-2004 has been provided by Pietsch et al. [123], They found that most prevalent victims of accidental plant exposures are children in the age of 1-6 years presumably being misled by the attractive plump berries. 

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... 

This group of compounds has both peripheral and central properties. It is known from ancient literature that atropine has psychotomimetic effects (extracts from Atropa belladona were used to induce hallucinations in wizards ). Central effects increase when the compounds are considered in the following rank atropine, scopolamine, benactyzine, Ditrane, and, finally, BZ and other esters of glycolic acid (Albanus, 1970). BZ was originally studied for the therapy of gastrointestinal diseases. But even in small doses it produces side effects, such as confusion and hallucinations. Therefore, BZ was withdrawn from commercial studies and turned over to the US Army as a possible candidate for incapacitating... 

Systemic reactions from the topical administration of scopolamine are quite similar to those of atropine. However, CNS toxicity appears to be more common with scopolamine than with atropine. In a series of several hundred patients whose pupils were dilated with 1% scopolamine, seven cases of confiisional psychosis were observed. The reactions included restlessness, confusion, hallucinations, incoherence, violence, amnesia, imcon-sciousness, spastic extremities, vomiting, and urinary incontinence. Others have reported similar acute psychotic reactions in children receiving from 0.6 to 1.8 mg of topically administered scopolamine. However, no deaths have been reported from topical ocular use of scopolamine.Treatment of toxic reactions is the same as that far atropine toxicity. 

In doses used clinically (0,5-1.0 mg), this effect is usually confined to mild vagal excitation. The rate and occasionally the depth of breathing are increased, but this effect is probably the result of bronchlolar dilatation and the consequent Increase in physiologic "dead space." With toxic doses of atropine, central excitation becomes more pronflnent, leading to restlessness, irritability, disorientation, hallucinations, or delirium. With still larger doses, stimulation is followed by depression, coma, and medullary paralysis. The latter may be primarily responsible for a fatal outcome. Even moderate doses of atropine may depress some central motor mechanisms that control muscle tone and movement. 

BZ (7.4 - 14.5 pg/kg) aerosol Inhalation, 2 subjects 3834 (2 0 mg) percutaneous, 1 subject Atropine (125 pg/kg) Intramuscular, 3 subjects Prolixin (15.0 - 23.0 pg/kg) Intramuscular, 6 subjects 302668 (10.0 pg/kg) Intravenous, 1 subject 302196 (75.6 Pg/kg) oral, 1 subject TAB (90 mg total) Intramuscular, 1 subject Pretreatment with methyl scopolamine (1.0 mg) 1 subject Only 2 subjects (AlOJ) and (AlOK) who received doses of BZ and were subsequently treated with physostlgmine, showed any prolonged central effects (hallucinations, disorientation, confusion) lasting 4 to 6 days post >exposure Both subjects were asymptomatic and appeared normal when discharged from test. One subject (AlCM)) was exposed to Prolixin (23.0 pg/kg) and then treated with multiple doses (1.0 mg X 7 doses) over a 2 ay period, intramuscularly At 27 hours post-exposure, the subject complained of blurred vision, and facial expression was mask-llke, tongue "thick" and jaws open. 

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