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INNOSC Theranostics and
Pharmacological Sciences Atropine-induced psychosis in organophosphate poisoning

occur. Among these, atropine-induced psychosis is a Management of atropine-induced psychosis involves a
5
rare phenomenon characterized by symptoms such as multifaceted approach, including the discontinuation of
restlessness, excitement, hallucinations, and delirium atropine, supportive care, pharmacological interventions,
following atropine administration. Although atropine and psychosocial support. Prompt recognition and
4
administration for OP poisoning is generally well-tolerated, cessation of the offending drug are crucial to preventing
allergic or toxic reactions, including atropine-induced further complications. 17,18 Supportive measures, such as
psychosis, are infrequently reported in the literature. 6 providing a calm environment and close supervision,
are essential for managing agitation and behavioral
Atropine-induced psychosis, though rare, is a 17-19
potentially serious adverse effect observed following disturbances. Pharmacological treatments may involve
atropine administration, particularly in the context of OP the use of antipsychotic medications, such as haloperidol,
poisoning. While the exact mechanisms underlying this risperidone, or olanzapine, as well as benzodiazepines
7
20
psychosis remain unclear, several hypotheses have been to manage acute agitation and anxiety. Psychosocial
proposed, including disruption of central cholinergic interventions, including psychoeducation, cognitive-
neurotransmission, altered dopaminergic signaling, and behavioral therapy, and family support, play a key role in
recovery and rehabilitation. Close monitoring of clinical
20
modulation of glutamatergic and GABAergic pathways. responses, side effects, and the risk of relapse is important
8
Clinically, this condition resembles acute psychotic to optimize outcomes and prevent recurrence. 19,20
disorders, such as schizophrenia or substance-induced
psychosis, and is marked by hallucinations, delusions, OP poisoning and atropine-induced psychosis present
agitation, confusion, and disorientation. Patients complex clinical challenges, especially in elderly patients
9
may exhibit erratic behavior, paranoia, and perceptual with comorbidities. Effective management requires a
disturbances, often requiring close monitoring and multidisciplinary approach, integrating expertise in
intervention to ensure their safety and prevent harm. 4,10 toxicology, pharmacotherapy, psychiatry, and geriatric
medicine to address the various complications associated
Several factors may pre-dispose individuals to atropine-
induced psychosis, including advanced age, pre-existing with OP exposure and anticholinergic therapy. By promoting
early recognition and implementing evidence-based
psychiatric disorders, substance abuse, polypharmacy, interventions, healthcare providers can improve outcomes
and underlying medical comorbidities. Elderly for elderly individuals at risk of OP poisoning and atropine-
6,11
patients are particularly vulnerable due to age-related induced psychosis. Continued research and collaboration
changes in drug metabolism, altered blood-brain barrier are needed to better understand the pathophysiology,
permeability, and reduced tolerance to anticholinergic risk factors, and treatment strategies of these conditions,
effects. Comorbidities such as dementia, Parkinson’s ultimately improving care for vulnerable populations.
7,12
disease, cerebrovascular disease, and cardiovascular
disorders may further increase susceptibility by disrupting We present a case report illustrating atropine-induced
neurotransmitter balance or impairing cognitive function. psychosis during the treatment of OP intoxication. Through
13
The concomitant use of medications with anticholinergic this report, we aim to elucidate the clinical presentation,
properties, such as antipsychotics, antidepressants, diagnostic approach, management strategies, and outcomes of
antihistamines, and antiparkinsonian agents, may also this rare adverse drug reaction, emphasizing the importance
heighten the risk of psychosis. 14 of vigilance in monitoring and managing complications
associated with atropine therapy in OP poisoning.
Diagnosing atropine-induced psychosis requires a
comprehensive clinical assessment, including a detailed 2. Case presentation
patient history, mental status examination, physical
15
evaluation, and exclusion of other causes. The DSM-5 A 45-year-old male presented to the General Medicine unit
criteria for substance-induced psychosis include the of OHRC, Hyderabad, India after ingesting 250 – 500 mL
onset of psychotic symptoms related to substance use, the of phenthoate insecticide at his residence. He was initially
absence of a primary psychotic disorder, and the resolution treated at a local hospital, where atropinization and gastric
of symptoms following cessation of the substance. lavage were performed. The details of the patient are
8,14
Laboratory tests and neuroimaging may be necessary summarized in Table 1.
to rule out other conditions that could contribute to Upon transfer to a tertiary care facility, a repeat gastric
psychosis, such as metabolic disturbances, infections, or lavage was performed, and the patient received 1 g of
drug intoxication. Toxicology screening for serum or pralidoxime (PAM) along with an atropine infusion at
11
urine levels of atropine can provide supportive evidence 30 mL/h. Hit treatment regimen also included ceftriaxone
for diagnosis. 16 (1 g IV Bis die [BD]), thiamine (100 mg IV BD),

Volume 7 Issue 4 (2024) 2 doi: 10.36922/itps.4607