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Cocaine as a Risk Factor for Neuroleptic-Induced Acute Dystonia

J Clin Psychiatry 1998;59(3):128-130

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.