Page 103 - ITPS-7-4

INNOSC Theranostics

and Pharmacological Sciences

CASE REPORT
Managing atropine-induced psychosis in

organophosphate poisoning: A case report

Mohammed Misbah Ul Haq* , Juveria Almas, Soha Amreen,
and Mohammed Zabeeruddin
Department of Pharmacy Practice, Deccan School of Pharmacy, Hyderabad, Telangana, India

Abstract

Atropine-induced psychosis, though rare, is a critical adverse effect that can arise
during the treatment of organophosphate (OP) poisoning, necessitating swift
recognition for optimal patient care. This case report describes the presentation of
a 45-year-old male with a history of chronic alcoholism and smoking, admitted for
OP intoxication, who developed acute psychosis after atropine administration. The
symptoms included hallucinations, agitation, and delirium, with diagnostic evaluation
confirming atropine-induced psychosis according to DSM-IV-TR criteria. The treatment
approach involved discontinuing atropine and providing supportive care, which
resulted in symptom resolution within several days. In addition, benzodiazepines were
administered to manage agitation and anxiety. This case highlights the need for careful
monitoring of drug reactions, particularly in patients with risk factors, such as chronic
alcoholism. It underscores the importance of individualized treatment strategies and
*Corresponding author: the critical role of healthcare professionals in recognizing and addressing atropine-
Mohammed Misbah Ul Haq
(drmdmisbah@outlook.com) induced psychosis. Further research is warranted to better understand the underlying
mechanisms and risk factors associated with this complication.
Citation: Misbah Ul Haq M,
Almas J, Amreen S, Zabeeruddin
M. Managing atropine-induced
psychosis in organophosphate Keywords: Atropine-induced psychosis; Organophosphate poisoning; Adverse drug
poisoning: A case report. INNOSC reactions; Psychiatric manifestations; Management strategies
Theranostics and Pharmacological
Sciences. 2024;7(4):4607.
doi: 10.36922/itps.4607
Received: August 21, 2024 1. Background
Accepted: October 10, 2024 Organophosphate (OP) insecticide poisoning remains a significant global health
1
Published Online: October 30, challenge, contributing to an estimated 100,000 deaths annually worldwide. These
2024 compounds exert their toxic effects by inhibiting acetylcholinesterase, leading to the
Copyright: © 2024 This accumulation of acetylcholine at cholinergic synapses and resulting in acute cholinergic
is an Open-Access article syndrome. Atropine, a naturally occurring alkaloid extracted from plants such as
2
distributed under the terms deadly nightshade (Atropa belladonna), is commonly employed as an antidote in the
of the Creative Commons
AttributionNoncommercial License, management of OP poisoning. However, high doses of atropine can cause adverse effects,
permitting all non-commercial use, including the rare but serious complication of atropine-induced psychosis. 3
distribution, and reproduction in any
medium, provided the original work Atropine functions by antagonizing the muscarinic effects of acetylcholine in both
is properly cited. the central and peripheral nervous systems, blocking neurotransmitter actions on post-
Publisher’s Note: AccScience ganglionic nerves and smooth muscles. Common side effects, such as xerostomia,
4
Publishing remains neutral with photophobia, blurred vision, and tachycardia, typically occur at or below therapeutic
regard to jurisdictional claims in
published maps and institutional doses. However, at toxic doses, more severe adverse effects, including dilated pupils,
affiliations. marked palpitations, restlessness, tremors, delirium, hallucinations, and fatigue, can

Volume 7 Issue 4 (2024) 1 doi: 10.36922/itps.4607