Cocaine as a Risk Factor for Neuroleptic-Induced Acute Dystonia
J Clin Psychiatry 1998;59:128-130
© Copyright 2014 Physicians Postgraduate Press, Inc.
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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.