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Phenothiazine-Induced Decompensation

Theodore Van Putten, MD; Louis R. Mutalipassi, PhD; Michael D. Malkin, MD
Arch Gen Psychiatry. 1974;30(1):102-105. doi:10.1001/archpsyc.1974.01760070080012.
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Adverse mental reactions to phenothiazines have been anecdotally reported. In a systematic study 80 patients with the diagnosis of schizophrenia received phenothiazines in conventional dosages. Nine patients experienced dramatic exacerbations of psychosis on phenothiazines with a piperazine side group—particularly fluphenazine enanthate.

These exacerbations of psychosis are associated with a subtle akathisia. Exacerbations of psychosis were promptly reversed by biperiden (Akineton)—an anticholinergic drug, given intramuscularly.

It is proposed that extrapyramidal involvement can have a prominent mental component which resembles an exacerbation of schizophrenia.

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