Physostigmine history

Relative contraindications to the use of anticholinesterase treatment include a history of cardiovascular disease, asthma, glaucoma, and gastrointestinal or genitourinary obstruction. Symptomatic treatment of tachyarrhythmias with propranolol may be considered P blockers, however, are less effective than physostigmine. 

This group investigated patients presenting with acute schizophrenic symptoms who underwent a drug-free washout period, received lithium only initially, and then antipsychotics later (374). Lithium was ineffective for classic schizophrenia, but some patients who met criteria for schizophreniform disorder did respond to lithium. Whether schizophreniform illness is a variant of mood disorders (a reasonable hypothesis in view of their lithium response) or a separate entity that is lithium-sensitive is still unclear. It is known that these patients have family histories that include mood-disordered as well as schizophrenic relatives. In a small pilot study, physostigmine (a drug with possible antimanic but no antipsychotic properties) benefited schizophreniform patients who responded to lithium, but had no effect in those who did not (Carver DL, personal communication). 

Basic and advanced life support measures should be utilized as necessary for atropine exposure. Gastric decontamination procedures should be employed based on the patient s history and current symptomatology. Activated charcoal can be given to adsorb atropine. The mainstay of treatment is supportive care. Physostigmine, a cholinesterase inhibitor, can be given to patients to reverse signs and symptoms of... 

IV. Diagnosis is based on a history of exposure and the presence of typical features such as dilated pupils and flushed skin. A trial dose of physostigmine (see below) can be used to confirm the presence of anticholinergic toxicity rapid reversal of signs and symptoms is consistent with the diagnosis. 

The antidote, physostigmine, can be used and is safe and effective if used properly. It is most effective after 4 hours from time of exposure, although effects from a single intramuscular injection of physostigmine last only about 60 minutes, requiring frequent re-dosing. Corrective resuscitative measures should take place primarily and it should not be used in a patient with cardiorespiratory compromise, hypoxia, or acid-base imbalance with a history of seizure disorders or arrhythmias. 

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