Am J Psychiatry 1976; 133:1018-1023
Copyright © 1976 by American Psychiatric Association
Reversal of tricyclic-overdosage-induced central anticholinergic syndrome by physostigmine
PC Holinger and HL Klawans
Although there is evidence that the delirium, stupor, coma, and seizure-
like activity seen in overdosage with tricyclic antidepressants and
antiparkinson drugs are due to the central anticholinergic activity of
these agents, patients with overdosage of these drugs are still frequently
misdiagnosed. The authors present a case of reversal of
anticholinergic-drug-induced prolonged coma, myoclonus, and choreoathetosis
by physostigmine. This report supports the anticholinergic basis of the
clinical manifestations of such overdosages, provides information on the
role of acetylcholine and dopamine in psychiatric and movement disorders,
and illustrates dramatically the need for accurate diagnosis and treatment.
