Atropinic psychosis

Description:

Atropine contains in a number of plants, eurysynusic in all parts of the world (at us in a dope, a henbane, etc.). Ability of these plants to cause changes of mentality is known within several millennia, in any case, since Ancient Greece and Rome. In the ancient time and in the Middle Ages they were used for religious ceremonies, sorcery, for the proof that the opponent has a mental disease, etc. Believe, for example, that the well-known pifiya — prophetesses of the temple of Apollo in Delphi — prophesied under the influence of a belladonna. Let's remind that prophecies of pifiya differed in the mysteriousness and incomprehensibility. At the same time a number of self-accusations — recognitions in communication with a devil, participation in a sabbath of witches, etc. during the Middle Ages era — quite often were a consequence of poisoning with atropine. Idea of atropine as about the mysterious means influencing soul of the person was reflected also in names of the plants supporting him — "dope", Herbe aux sorciers (a grass of sorcerers), Herbe au diable (a grass of a devil). And the name atropine comes from a name of Atropy — the Ancient Greek goddess of destiny Moira (or Parks) who was cutting off thread of human life.

Descriptions of the mental disorders caused by the dope (containing except atropine close to it on a structure and the mechanism of action Scopolaminum and Hyoscyaminum) and other plants belonging not to doctors are known also for a long time. The condition of senseless excitement at soldiers of the Roman commander Anthony who overturned each stone in the field is so described. Beverley in 1676 described poisoning with a dope at group of soldiers who were excited, rode on the ground, made senseless actions, grimaced, barked, laughed, some of them fell into coma.

Symptoms of Atropinic psychosis:

As a rule, atropinic psychosis proceeds in the form of a delirium. Patients are not oriented in time and a surrounding situation, do not recognize people around, including relatives — parents, children, the wife or the husband, and sometimes — and in own personality. They test plentiful visual hallucinations in the form of separate objects, people, small animals, snakes, etc. or the whole scenes which are quickly replacing one another. Hallucinatory images can be uniform, stereotypic, but can be and brightly painted, changeable; Also tactile hallucinations Are frequent. Hearing hallucinations which can be as elementary (separate sounds, noise are more seldom observed. knock, a scratch, beeps), and difficult in the form of the voices pronouncing separate words and the whole phrases. We observed at one of our patients and olfactory hallucinations though in literature emergence of such hallucinations at atropinic psychoses is usually denied. The maintenance of hallucinations can be various — menacing, pleasant or just indifferent, not connected with the identity of patients. Hallucinatory images are projected outside, can be both flat, and volume, sometimes hide the real objects surrounding him from the patient.

Changes of coloring of all surrounding are less often observed: everything is painted in yellow, green, pink colors which replace one another, the phenomena of a derealization and depersonalization — objects increase, bent, hands and legs become heavy, are extended, the head separates from a body, etc. It is possible that the rarity of similar descriptions depends on the fact that many patients cannot remember the experiences or give their complete description. Patients are usually fussy, catch something in air, are enough on a floor, put something in a mouth, chew, shake some objects from hands, clothes. It can be observed and sharp senseless excitement during which patients try to run somewhere is made by random motions, at the same time they as if do not notice barriers on the way, bypass them, in a literal sense "climb on a wall", the movements are badly coordinate, convulsive twitchings of muscles are sometimes noted. The speech is inconsistent, sketchy, often incoherent, is sometimes not legible at all. The sketchy crazy ideas which are thematically connected with the nature of hallucinatory experiences can be it want to do harm, to burn, poison, etc. The mood of patients is connected with the nature of their experiences. The fear, alarm, malignancy are more often observed, but patients can be cheerful, eyforichny or is quiet, with some interest to watch the events. At objective inspection of patients wide pupils, slackness or lack of reaction of pupils to light and accommodation (if it is possible to achieve from sick implementation of instructions), the dry, covered with a white or brown plaque language, a xeroderma and mucous — from here usually strong thirst, a hoarse voice, a hyperemia of the person, tachycardia and increase of breath attract attention. Other symptoms are less constant. Increase in tendon jerks, muscular hypertension and convulsive twitchings of muscles, ataxy, dizzinesses, the greased speech, fervescence and arterial pressure, a leukocytosis can be observed. Cerebrospinal fluid was investigated seldom, cases of significant increase in number of cells (lymphocytes) in liquor are noted.

In view of short duration of atropinic psychoses, small number of observations of most of authors, and also, maybe, in connection with insignificant interest in recent years in atropinic psychoses which are considered rather well studied biochemical researches at them (as, however, and at the majority of medicinal psychoses) were almost not conducted. We found such researches only in works of the prof. M. A. Goldenberg and his employees who found the decrease in vakat-oxygen in urine going parallel to recovery at 3 patients with atropinic psychoses (increase in vakat-oxygen during psychosis managed to be fixed only in experiences on dogs), the low content of ascorbic acid during psychosis and its increase after improvement. In experiences on dogs whose behavior disorders very reminded a picture of atropinic psychosis at the person, changes of protein fractions of blood and decrease of the activity of cholinesterase of blood serum are noted, besides, during "psychosis". It should be noted that expressiveness and abundance of somatic and neurologic disturbances do not find constant correlation with weight of mental disturbances though at the same patient the expressiveness of vegetative shifts, maximum for it, usually matches the maximum expressiveness of mental disturbances.

Atropinic psychosis usually develops sharply, mental disturbances quickly accrue, reaching the greatest expressiveness in several hours. At a serious poisoning the delirious state can be replaced by a sopor or a coma. Duration of psychosis is usually estimated for hours or days. Only in isolated cases they can drag on for a week and more. From 15 patients observed by us with atropinic psychoses 12 recovered less, than in a day, at two patients the delirium proceeded 21/2 days and only one patient has about 2 weeks. The atropinic delirium usually comes to an end with recovery, often after a dream, and its duration can be small — 6 — 8 hours. However mental disturbances can continue also after a dream. In these cases they usually amplify or again appear in the evening as it is observed also at other intoksikatsionny and infectious psychoses. After the termination of a delirium within several days the adynamy can remain: increased fatigue, weakness, unstable mood with tearfulness or irritability, but quite often sick in the first day after the termination of psychosis feel healthy and at inspection no signs of an adynamy are found. The mydriasis and disturbance of accommodation usually remain during one — several days after the termination of psychosis. Patients badly see, especially at a short distance — objects, especially letters, merge, reading is complicated. As well as the adynamy, completeness of memories of experiences during psychosis can be various. A part of patients remembers nothing an event with them; after an exit from psychosis these patients with surprise find out that they are in hospital, at others amnesia has partial character and about endured sketchy, incomplete memoirs remain. At last, a part of patients keeps quite full reminiscence of the experiences during psychosis. Inability of the patient to give the full and consecutive account on what happens to it during psychosis can be a consequence of abundance of the bright, quickly replacing each other images and scenes which the patient is simply not able to remember. It seems to us that it is not absolutely correct to carry such cases to dysmnesias (R. Ya. Golant classified them as "a syndrome of mnestichesky accumulation") — and the healthy person even with very good memory would be hardly capable to remember such variety of pictures, thematically poorly connected among themselves.

It must be kept in mind that the forecast of an atropinic delirium is not always favorable and if medical events timely were not held, can — though in rare instances — to come death. During an atropinic delirium some researchers allocate several stages or phases. V. V. Shostakovich and сотр. distinguish the gipersimpatotonichesky phase which is characterized by somatic changes and excitement, a mental stage and a stage of a sopor or a coma. The prof. M. A. Goldenberg allocates 4 stages: 1) the accruing oglushennost, 2) the accruing stupefaction, 3) involution of disorders of consciousness and 4) an adynamy.

With reliability it is possible to state at patients only the second stage — stupefactions or mental. The changes preceding it are often so short-term that most of patients gets under observation of the doctor after their disappearance (or replacements following — the second — a stage) and the picture of initial changes of behavior should be reconstructed according to stories of the family who is often not able to give about it the clear account. The sopor and a coma develop not always, and only at the most serious poisoning. The phase of involution can be tracked only at patients with longer course of psychosis, and the adynamy as it was already mentioned above, is not obligatory.

Reasons of Atropinic psychosis:

Can be the cause of psychosis as accidental poisoning with a henbane, dope or atropine, and drug poisoning — when atropine is applied on doctor's orders. The criminal poisoning mentioned in S. S. Korsakov's guide practically does not meet now, in any case in the USSR. In foreign literature references of use, hl meet. обр. Scopolaminum in criminal intents to cause a picture of a mental disease or to bring the victim to a helpless state, for example, for the purpose of rape. The woman at the same time can not show resistance and fulfills requirements imposed to her "with open eyes, but with the connected spirit", and afterwards remembers nothing an event.

There are also data that the police in some countries of Latin America uses Scopolaminum to achieve recognition of the person suspected of commission of an offense. At the same time the condition of weakness of a will caused by Scopolaminum at which interrogated tells about things, usually by it hidden is used.

In some parts of Central and South America, Africa and Asia of a plant, the containing atropine and Scopolaminum, are used for receiving an ebrietas so far. Possibly and prolonged use with accustoming and the phenomena of abstinence at an otnyatiya. At the same time the condition of full indifference to the events can develop around therefore Indians call such people by "live corpses". In Europe, the USA chronic abuse of atropine and Scopolaminum is not described.

Most often psychosis develops after single or short-term dose of high doses of atropine, is much more rare at long course treatment. As the picture and the course of psychosis at poisoning with a henbane (or a dope) and the sulfate atropine prepared in a drugstore are identical, we provide their general description.

Treatment of Atropinic psychosis:

Treatment of acute atropinic psychoses consists in appointment of antagonists of atropine — Pilocarpinum, Eserinum, however in most cases psychosis disappears also without their use. The gastric lavage, appointment emetic or laxative is reasonable only at poisoning with a dope or henbane or after atropine reception inside, in the latter case — if there is an opportunity to make washing the first minutes, at most an hour after atropine reception since its absorption happens quickly. At disturbances of cordial activity cardiacs (camphor, caffeine) are shown. We doubt expediency of purpose of caffeine since observed the psychoses similar with atropinic at poisoning with caffeine. It is usually possible to be limited to purpose of hypnagogues. In a number of textbooks and the guides purpose of morphine is recommended, however in literature there are instructions that morphine is synergist of high doses of atropine therefore use it cannot be considered rather reasonable. In cases of development of a coma appoint stimulators, and at convulsive attacks — anticonvulsants.

At long psychoses it is necessary to cancel first of all atropine (Scopolaminum, артан etc.) if the somatic condition of patients does not cause fears, it is enough to appoint antagonists of atropine, sedative or neuroleptics, vitamins, injections of glucose, normal saline solution. The current and an outcome of these psychoses are favorable that does, our way to opinion, excessive use of such means as the electroconvulsive therapy applied by some foreign authors.