Phenothiazine-Induced Decompensation

Adverse mental reactions to phenothiazines have been anecdotally reported. In a systematic study 80 patients with the diagnosis of schizophrenia received phenothiazines in conventional dosages. Nine patients experienced dramatic exacerbations of psychosis on phenothiazines with a piperazine side group—particularly fluphenazine enanthate. These exacerbations of psychosis are associated with a subtle akathisia. Exacerbations of psychosis were promptly reversed by biperiden (Akineton)—an anticholinergic drug, given intramuscularly. It is proposed that extrapyramidal involvement can have a prominent mental component which resembles an exacerbation of schizophrenia.