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Abstract

Antipsychotic drugs can cause adverse extrapyramidal side effects in patients. For this reason, anticholinergic drugs are used in treatment protocols to manage extrapyramidal syndromes. However, high doses of these drugs may lead to anticholinergic syndrome in patients. Sometimes, in complex and extremely aggressive patients, it seems that the occurrence of secondary aggression is due to the presence of anticholinergic syndrome, which unfortunately is ignored.

The patient is a 38-year-old woman with a 7-year history of bipolar disorder, who, due to her non-use of medication, was treated with biperiden along with antipsychotic drugs to control her symptoms. Due to secondary aggression resulting from the occurrence of anticholinergic syndrome, these symptoms were confused with the initial psychotic symptoms of the patient. As a result, the presence of anticholinergic syndrome was neglected, and the dose of the antipsychotic medication was increased. This led to a vicious cycle in the process of treatment. It seems that psychiatrists should be more careful about the use of antipsychotic drugs in acute patients and the presence of anticholinergic syndrome should not be neglected‎.