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The Primary Care Companion For CNS... Aug 2023To evaluate real-world treatment patterns for patients initiating benztropine and to understand treatment approaches in patients with drug-induced movement disorders...
To evaluate real-world treatment patterns for patients initiating benztropine and to understand treatment approaches in patients with drug-induced movement disorders from a health care provider perspective. A retrospective claims analysis was conducted among patients with evidence of benztropine initiation from January 2017 through March 2020 to assess treatment patterns and patient health care resource utilization. Subsequently, a 30-minute, United States-based online survey fielded from December 2021 to January 2022 was sent to physicians, nurse practitioners, and physician assistants who reported a primary care or psychiatry specialty currently treating drug-induced movement disorders and prescribed benztropine. The health care claims analysis included 112,542 patients. Polypharmacy and multiple comorbidities were frequent characteristics in this population; 54.1% of patients had ≥ 2 comorbidities at baseline, and 59.1% had claims for > 10 medications. Benztropine was used for > 3 months in > 50% of the population. Health care costs and resource utilization were high, with mean all-cause pharmacy and outpatient costs totaling $11,755. Survey results from 349 primary care or psychiatry health care providers indicated that benztropine is often used in non-tardive dyskinesia drug-induced movement disorders but frequently continued for > 3 months or used in tardive dyskinesia. In this study, psychiatry providers prescribed benztropine in line with guideline recommendations more often than primary care providers; however, < 40% indicated familiarity with 2020 American Psychiatric Association Practice Guideline for the Treatment of Patients with Schizophrenia. These complementary analyses suggest that benztropine is used long-term in non-tardive dyskinesia drug-induced movement disorders and in tardive dyskinesia despite risks of worsening tardive dyskinesia or adverse effects. .
Topics: Humans; Benztropine; Insurance Claim Review; Retrospective Studies; Movement Disorders; Tardive Dyskinesia; Health Personnel
PubMed: 37671827
DOI: 10.4088/PCC.22m03472 -
Medicine Dec 2023This case report presents a unique acute dystonic reaction (ADR) induced by metoclopramide in a 6-year-old male patient with pertussis-associated vomiting. The rarity of...
INTRODUCTION
This case report presents a unique acute dystonic reaction (ADR) induced by metoclopramide in a 6-year-old male patient with pertussis-associated vomiting. The rarity of such a reaction in pediatric patients underscores the significance of this case in contributing to the scientific literature. This report highlights the need for heightened awareness of the potential adverse effects of medications commonly used in pediatrics and emphasizes the importance of tailored interventions for this population.
MAIN SYMPTOMS AND IMPORTANT CLINICAL FINDINGS
Following the administration of metoclopramide for vomiting associated with pertussis cough, the patient exhibited distressing symptoms, including torticollis, facial grimacing, and tongue protrusion. These involuntary movements were promptly recognized, leading to the suspicion of an ADR. The clinical findings underscore the importance of vigilant monitoring for extrapyramidal symptoms following medication administration, especially in children.
THE MAIN DIAGNOSES, THERAPEUTIC INTERVENTIONS, AND OUTCOMES
The primary diagnosis of ADR induced by metoclopramide was confirmed, prompting the cessation of the medication and the initiation of anticholinergic therapy with benztropine. This intervention rapidly resolved the patient's symptoms, highlighting the importance of tailored and swift therapeutic strategies. The outcome demonstrated the efficacy of timely intervention in managing ADR in pediatric patients.
CONCLUSION
The main takeaway lesson from this case lies in the critical need for healthcare practitioners to remain vigilant for potential adverse reactions in pediatric patients, even when prescribing commonly used medications. The successful management of this case underscores the importance of prompt recognition, appropriate interventions, and continuous monitoring. Ultimately, this case contributes to the scientific literature by highlighting the unique manifestation of ADR in a pediatric patient, reinforcing the significance of individualized patient care and medication safety.
Topics: Male; Humans; Child; Metoclopramide; Whooping Cough; Vomiting; Dyskinesias; Torticollis
PubMed: 38050314
DOI: 10.1097/MD.0000000000036140 -
Frontiers in Psychiatry 2023Antipsychotic-induced catatonia is an iatrogenic and debilitating adverse reaction, but there is a dearth of recent documented cases. This report describes a 35-year-old...
Antipsychotic-induced catatonia is an iatrogenic and debilitating adverse reaction, but there is a dearth of recent documented cases. This report describes a 35-year-old incarcerated Korean-American male with a history of unspecified psychosis who presented for antipsychotic induced catatonia after administration of haloperidol decanoate intramuscular (200 mg across the span of 1 week). Neurologic workup was performed including MRI, lumbar puncture, and electroencephalography. Despite an approximate month long hospitalization, benzodiazepine challenge, benztropine trial, and amantadine adjunct, our patient continued to experience bradykinesia, waxy flexibility, and mask-like facies, and was minimally verbally responsive. Several challenges in the treatment of incarcerated individuals at the hospital are highlighted in this case report, including adverse reaction to medication, difficulty of care coordination, and limited access to health records among providers.
PubMed: 37720901
DOI: 10.3389/fpsyt.2023.1092253 -
Cureus Jul 2023Dysphagia has been associated with antipsychotic drug use. This case report describes the management of dysphagia in a psychiatric patient who presented to the emergency...
Dysphagia has been associated with antipsychotic drug use. This case report describes the management of dysphagia in a psychiatric patient who presented to the emergency department from a psychiatric facility after choking on a hot dog. The patient was on risperidone 4 mg, initiated a month prior to treat acute psychosis. Foreign body removal from the distal trachea was performed by bronchoscopy, followed by a swallow evaluation by the speech and swallow team. The patient exhibited severe oropharyngeal dysphagia, leading to aspiration pneumonia and subsequent enteral feeding through a nasojejunal tube. Changes in medication from risperidone to aripiprazole, along with a short course of benztropine and dietary modifications, were implemented, with gradual improvement in swallowing function observed during the hospital stay. The patient's complex medical and psychiatric history contributed to a prolonged hospital stay.
PubMed: 37637547
DOI: 10.7759/cureus.42491 -
Cureus Dec 2023Belly dancer's dyskinesia (BDD) is an unusual neurological disorder characterized by focal dyskinesia that results in involuntary, rhythmic movements of the anterior...
Belly dancer's dyskinesia (BDD) is an unusual neurological disorder characterized by focal dyskinesia that results in involuntary, rhythmic movements of the anterior abdominal wall. This case report comprehensively examines the presentation, potential medication-induced etiology, and therapeutic response of a 64-year-old male diagnosed with schizophrenia. The patient developed BDD-like symptoms resembling hiccups, experiencing recurrent episodes that endured for hours and occurred nearly daily, significantly affecting wakefulness and sleep. Importantly, the patient's medical history included the utilization of fluphenazine and benztropine for schizophrenia management. Following a thorough multidisciplinary neurology consultation, a tailored treatment regimen involving clonazepam, promethazine, and baclofen was initiated, culminating in a noteworthy reduction in symptom frequency. This report substantially enriches the existing knowledge of BDD, highlighting the critical necessity to elucidate its intricate pathophysiology for the advancement of refined diagnostic and therapeutic strategies.
PubMed: 38161556
DOI: 10.7759/cureus.49796 -
Cureus Nov 2023Oculogyric crisis (OGC) is a rare type of acute dystonia characterized by spasmodic upward deviation of the eyes lasting for a few minutes to several hours. It is...
Oculogyric crisis (OGC) is a rare type of acute dystonia characterized by spasmodic upward deviation of the eyes lasting for a few minutes to several hours. It is commonly seen with the administration of first-generation antipsychotics and rarely reported in patients taking second-generation antipsychotics. Although aripiprazole, a second-generation antipsychotic, is known for its low potential for extrapyramidal side effects (EPS), there are multiple case reports of it resulting in acute dystonia, especially OGC. In this paper, we report a case of aripiprazole-induced OGC in a 16-year-old female patient after a suicide attempt by taking 40 mg of aripiprazole and 5 g of acetaminophen. The necessary investigations were ordered, and the patient's dystonic symptoms resolved completely after administering parenteral diazepam and benztropine.
PubMed: 38054149
DOI: 10.7759/cureus.48267 -
Case Reports in Hematology 2024Hairy cell leukemia (HCL) is an infrequent and persistent B-cell inert lymphoid leukemia. In this study, we present the case of a 71-year-old female patient with a...
Hairy cell leukemia (HCL) is an infrequent and persistent B-cell inert lymphoid leukemia. In this study, we present the case of a 71-year-old female patient with a previous diagnosis of variant HCL who experienced a severe herpes zoster infection leading to an extensive skin eruption. The patient's initial diagnosis of HCL occurred 7 years ago, and she underwent treatment with cladribine, interferon, COP (cyclophosphamide, vincristine, and prednisone), benztropine tablets + clarithromycin dispersible, and ibrutinib. Immune disorders resulting from repeated prior chemotherapy and targeted therapy may potentially precipitate herpes zoster infection. Despite an initial two-week period of unresponsiveness to antivirals and nerve nutrition treatments, the introduction of topical Coptis liquid to the treatment regimen yielded significant efficacy. This case report underscores the potential of Chinese medicine as an adjunct to conventional antiviral therapy in the management of herpes zoster infection in immunocompromised patients. This treatment protocol has the potential to enhance efficacy, enhance quality of life, and serve as a more robust foundation for clinical diagnosis and improved treatments.
PubMed: 38440158
DOI: 10.1155/2024/1575161