COCAINE AS A RISK FACTOR FOR NEUROLEPTIC-INDUCED ACUTE DYSTONIA

Background: A prospective study was conducted to test the hypothesis t hat cocaine use is a risk factor for neuroleptic-induced acute dystoni a (NIAD). Method: The study sample consisted of a highrisk group for N IAD, males aged 17-45 years who had received high-potency neuroleptics within 24 hours of admission and had not used neuroleptics in the mon th prior to admission. Patients were excluded if they suffered from a neurodegenerative disorder or were exposed to anticholinergics, benzod iazepines, promethazine, carbamazepine, phenytoin, or levodopa during the study. Twenty-nine patients-9 cocaine users and 20 nonusers-entere d the study, which lasted 2 years. Patients were followed for 7 days. Results: Cocaine-using psychiatric patients developed significantly mo re 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 su ggest that cocaine-using psychiatric patients who are started on a reg imen of neuroleptics should also be administered an anticholinergic fo r at least 7 days to prevent NIAD.