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This is a report on a 62-year-old Chinese woman with Parkinson's disease (PD) for 8 years who developed myasthenia gravis (MG) in the last year. In this case, there was no adverse effect of trihexyphenidyl on MG, whereas pyridostigmine worsened the PD.
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The parenteral long-acting phenothiazines are drugs frequently used in the treatment of hospitalized and ambulatory psychiatric patients. The usual side effects of these drugs are familiar to psychiatrists. However, the "Neuroleptic malignant syndrome" reported in this paper can give rise to considerable diagnostic difficulty. The clinical characteristics and differential diagnosis of this syndrome are described with a care report. The need for prompt initiation of adequate therapy is stressed.
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A 65-year-old female patient was admitted to the hospital for cellulitis. She had a history of diabetes mellitus and parkinsonism on levodopa/carbidopa, rasagiline, ropinirole, trihexyphenidyl, amantadine, metformin, and glipizide. We present here a case of rare incidence of serotonin syndrome associated with linezolid and rasagiline.
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It was demonstrated in cat experiments that impairment of the retrieval of appetitive instrumental conditioning observed after systemic administration of antagonists of muscarinic central cholinoreceptors scopolamine (a nonselective M1 antagonist) and trihexyphenidyl (relatively selective M1 antagonist) could be connected with central and peripheral side effects of these antagonists. It was established that in case of the absence of side effects (low doses of trihexyphenidyl, 1 mg/kg) the blockade of M1-cholinoreceptors led either to selective fall-off of the motor instrumental reaction with in the presence of contextual behavior and other conditioned reactions or the appearance of errors that seemingly was indicative of the disturbance of triggering and realization of the motor program as the most important component of conditioning performance. The systemic injection of trihexyphenidyl (10 mg/kg), scopolamine (0.03 and 0.06 mg/kg) and nonselective peripheral antagonist methylscopolamine (0.03 mg/kg) led to changes in the general functional state (disorders in the emotional and motivational sphere), the expression of which depended on the individual sensitivity to anticholinergic drugs. The disturbance of CR retrieval observed in parallel with side reactions was characterized by a complete cessation of conditioning and apparently was not associated with memory deterioration.
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After a mean post-operative follow-up period of 22.3 months, the scores of axial symptoms on UPDRS part II (ADL score) and part III (motor score) deteriorated by 87% and 54% (baseline), respectively, compared with the pre-operative scores (P < 0.001 for both comparisons). After adding trihexyphenidyl to dopaminergic medication with stimulation, the scores of axial symptoms on UPDRS part II and part III improved from baseline by 33% and 39%, respectively (P < 0.001 for both comparisons).
In France, the observation and evaluation of drug abuse and dependence associated with pychoactive medications are the responsibility of the National Commission for Narcotics and Psychotropic Drugs. In order to assist this commission, several centres for evaluation and information on pharmacodependence (CEIP) were created throughout in France. Recently, in order to complete their epidemiological tools, several centres have developed another pharmacoepidemiological approach using data for refunded prescriptions obtained from the local and regional French Health Insurance database. This article underlines the potential contribution of the Health Insurance database to improving knowledge of drug use in the real-life conditions based on studies performed by the CEIP. Several examples are given showing the extent of the possibilities (population-based studies, cohort studies, development of misuse indicators). In spite of their limitations (e.g. the difference between consumption and delivery), these examples confirm that these database may be a novel tool for CEIP to assess a potential abuse of a medication.
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The analysis of hair is now accepted as a recognised alternative method for the determination of drug misuse. It has several advantages over the biological fluids; blood and urine, including collection of information regarding long-term drug use and determination of compliance with treatment programmes. In Jordan, the abuse of Artane (benzhexol hydrochloride) has been recognised as the most commonly abused drug among Jordanian youths. Hair samples were collected from nine patients (Male 25-55 years, M=39.11, SD=10.53, CV=26.93%). Samples were analysed for the presence of benzhexol and the toxicological analysis revealed the presence of benzhexol in all samples and its concentration ranged from 0.104 to 7.81 ng/mg hair. Solid phase extraction and GC-MS on selective ion storage (SIS) were used for extraction and detection of the drug with papaverine as external standard. The mass detector was operated at selective ion storage (SIS) to monitor the m/z of 98 and 218 for benzhexol and m/z 339 and 324 for the papaverine. The retention times of benzhexol and papaverine were 6.77 and 12.48 min, respectively. The method was linear in the range of 0.5 to 40 ng/mg hair, with a mean coefficient of determination (R2=0.9982). The limit of detection was 0.04 ng/mg. The intra- and inter-day variations were 3.85% and 3.35%. Recovery was found to be above 90%.
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We have measured acetylcholine (ACh) content and turnover rate (TRACh) in striatum and cortex of rats receiving haloperidol and clozapine i.p. Both clozapine (30 mumol/kg) and haloperidol (10 mumol/kg) reverse the decrease in striatal TRACh elicited by apomorphine (11 mumol/kg) while each antipsychotic affects the steady state and the TRACh in striatum differently. Haloperidol fails to change striatal ACh content but increases the TRACh; chozapine (15 and 30 mumol/kg) neither decreases the content of ACh nor changes the TRACh in striatum. Moreover, 60 or 90 mumol/kg of clozapine causes a 40% decrease in ACh content without affecting the TRACh. Clozapine, but not haloperidol, antagonizes the increase in ACh content and the decrease in TRACh elicited by arecoline (64 mumol/kg) and oxotremorine (9 mumol/kg) in striatum. Clozapine resembles trihexylphenidyl (14 mumol/kg) and benztropine (12 mumol/kg) because it decreases the ACh content of striatum without changing the TRACh. Moreover, clozapine and benztropine reverse the increase in striatal TRACh elicited by haloperidol. The increase in striatal TRACh elicited by haloperidol could be of value to explain the extrapyramidal action of this drug. The anticholinergic action of clozapine could explain the absence of extrapyramidal side effects observed with this drug.