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Cocaine as a risk factor for neuroleptic-induced acute dystonia
P N van Harten1, J C van Trier, E H Horwitz
1Psychiatric Hospital (Dr. D. R. Capriles Clinic), Curaçao, The Netherlands Antilles.
Background:
A prospective study was conducted to test the hypothesis that cocaine use is a risk factor for neuroleptic-induced acute dystonia (NIAD).
Method:
The study sample consisted of a high-risk group for NIAD, males aged 17-45 years who had received high-potency neuroleptics within 24 hours of admission and had not used neuroleptics in the month prior to admission. Patients were excluded if they suffered from a neurodegenerative disorder or were exposed to anticholinergics, benzodiazepines, promethazine, carbamazepine, phenytoin, or levodopa during the study. Twenty-nine patients--9 cocaine users and 20 nonusers--entered the study, which lasted 2 years. Patients were followed for 7 days.
Results:
Cocaine-using psychiatric patients developed significantly more NIAD than did nonusers (relative risk = 4.4, 95% CI = 1.4 to 13.9).
Conclusion:
Cocaine use is a major risk factor for NIAD and should be added to the list of well-known risk factors. The authors strongly suggest that cocaine-using psychiatric patients who are started on a regimen of neuroleptics should also be administered an anticholinergic for at least 7 days to prevent NIAD.