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Are Prophylactic Antiparkinson Drugs Necessary?  A Controlled Study of Procyclidine Withdrawal

Arthur Rifkin, MD; Frederic Quitkin, MD; John Kane, MD; Fred Struve, PhD; Donald F. Klein, MD
Arch Gen Psychiatry. 1978;35(4):483-489. doi:10.1001/archpsyc.1978.01770280093010.
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• Of 55 aftercare patients receiving long-term treatment with antipsychotic and antiparkinson (AP) drugs, 37 were switched to being given placebo, and 18 remained on a regimen of procyclidine hydrochloride. The dose of antipsychotic was kept constant. After three weeks extrapyramidal side effects (EPS) developed in 54% of those patients receiving placebo and in none of those receiving procyclidine (P <.002): Twenty-seven percent of the placebo group had EPS without akinesia, and in the same percentage akinesia developed (P =.003). We believe the risk-benefit ratio favors the routine use of AP drugs for prophylaxis and maintenance so as to avoid misdiagnosing as psychopathology, unspontaneity due to akinesia, and to reduce unreliable pill-taking due to EPS.

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