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SUMMARY This study assessed the efficacy of synthetic anticholinergic benztropine and incidence of side‐effects in 20 developmentally‐disabled patients with severe drooling. The double‐blind, placebo‐controlled, crossover protocol included one‐week baseline, two‐week placebo and two‐week benztropine conditions (mean dose 3·8mg). A significant decrease in drooling during the benztropine condition relative to placebo was demonstrated and conservative response rates (calculated by deleting placebo responders), ranged up to 65 to 70 per cent. For patients completing the protocol the incidence of side‐effects did not differ across conditions and minor problems such as a dry mouth were eliminated by small dose adjustments. More serious cholinergic side‐effects, which resolved within 24 to 48 hours, necessitated discontinuation of the drug in three patients. This study demonstrates that synthetic anticholinergics can provide an important therapeutic alternative to surgical and behavioral therapies for drooling. RÉSUMÉ Efficacité de la benzatropine synthétique dans le traitement du bavage Cette étude apprécie l'efficacité et l'incidence des effets secondaires d'un anticholinérgique, la benzatropine synthétique, chez vingt sujets en incapacité par retard de développement, qui bavaient beaucoup. Le protocole en double aveugle, contrôle placébo et experimentation croisée comportait une semaine de réference, deux semaines de placébo et deux semaines sous benzatropine (dose moyenne de 3·8 mg). Une diminution significative du bavage sous benzatropine par rapport au placébo fut démontrée avec taux de réponse apprécies conservativement (calculés en supprimant les réponses placébo) atteignant jusqu’à 65 ou 70 pour cent. Chez les sujets à protocole rempli, l'incidence des effets secondaires ne différait pas des conditions croisées et les problèmes mineurs comme la sécheresse de la bouche furent facilement éliminés par de faibles ajustements de dose. Des effets secondaires cholinergiques plus sérieux, disparaissant en 24 à 48 heures, nécessitèrent l'arrêt de traitement chez trois sujets. Cette étude démontre que les anticholinergiques synthétiques peuvent fournir une alternative théiapeutique au traitement chirurgical ou comportemental. ZUSAMMENFASSUNG Der therapeutische Erfolg einer Behandlung mit synthetischem Benztropin beim Speichelfluβ In dieser Studie werden Wirkung und Nebenwirkungen des synthetischen, anticholinergisch wirkenden Benztropin bei 20 behinderten Patienten mit starkem Speichelfluß untersucht. Die Doppelblind‐, Placebo kontrollierte‐, Wechselstudie beinhaltete eine Woche ohne Therapie, zwei Wochen Placebo und zwei Wochen Benztropin (mittlere Dosis 3 · 8mg). Während der Benztropintherapie ließ der Speichelfluß im Vergleich zur Placebobehandlung signifikant nach und der Therapieerfolg lag bei 65 bis 70 Prozent (nachdem die Placebo Responder eliminiert worden waren). Bei den Patienten, die die Studie beendeten, unterschied sich die Häufigkeit von Nebenwirkungen bei den unterschiedlichen Bedingungen nicht und geringe...

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Antipsychotic dosing for acute mania has not been well studied. Combined treatment with lithium and an antipsychotic is the most common treatment, but additional antimanic efficacy of a lithium-antipsychotic combination beyond that of an antipsychotic alone has not been well demonstrated. Furthermore, the possibility that lithium could affect antipsychotic dose requirement is believed to have never been studied. In this study, 63 acutely psychotic bipolar manic inpatients were randomly assigned to receive double-blind treatment with 1 of 2 haloperidol doses, 25 mg/day or 5 mg/day, for 21 days. In addition to haloperidol, subjects were randomly assigned to receive concomitant treatment with placebo, standard lithium, or lorazepam 4 mg/day. The high haloperidol dose produced greater improvement and more side effects than did the low dose. Lithium added to the low dose produced a markedly greater clinical response than did the low dose alone. Lorazepam did not improve the outcome for the patients receiving low-dose haloperidol. The clinical response produced by high-dose haloperidol was not enhanced by adding either lithium or lorazepam. All treatment effects emerged by the fourth day of treatment and persisted. Used alone, a haloperidol dose of 5 mg/day is too low for most manic patients, but concomitant lithium produces a dose-dependent enhancement of haloperidol response. Lorazepam 4 mg/day was insufficient to produce an advantage when added to low-dose haloperidol.