An unusual Adverse Reaction With Butyrophenone Therapy

Il s'agit d'une critique, d'ordre épistémologique, de l'antipsychiatrie. L'auteur démonte et démystifie l'antipsychiatrie qui est non une science mais une idéologie. Elle retourne contre eux I'argumentation des antipsychiatres, ceux de I'éole anglaise et en particulier Laing et Cooper, qui tiennent la folie et le fou pour des fabrications idaologiques de certains groupes sociaux. Ces groupes (famille, hôpital ou société globale) cherchent. par là, à obtenir et légitimer des privilèges matériels et psychologiques. Mais les antipsychiatres qui rejettent rationalité et scientificité s'enferment, à leur insu, dans un autre système et versent dans le rousseauisme naturaliste et l'utopie.

Retenons de cette étude que le malade mental n'a pas besoin que de chimiothérapie, mais de beaucoup de respect et de comprehension. Le psychiatre éclairé met sa technique au service de l'humain. S'il déient un pouvoir, c'est pour aider, non pour dominer.

Haloperidol, a butyrophenone preparation. has been increasingly used for the rapid control of the acute symptoms of schizophrenia (2), manic states (5), Gilles de la Tourette's syndrome (3. 4) and as an antiemetic in obstetric patients. Recently an unusual adverse reaction was encountered here -- urinary retention associated with haloperidol therapy at St. Mary's Hospital (SMH). Montreal. This appeared to be associated with a prodromal reaction of abdominal fullness, discomfort, and constipation. The following is a review of the case histories with a discussion.

Case I

A 37-year-old female was admitted to SMH on 21 February 1973 with symptoms of agitation, excitement and elation. A full

Case II

A 35-year-old unemployed single woman was admitted to SMH on 16 February 1973, with psychotic symptoms. On physical examination, the only positive finding was that of a marked congenital hip deformity and resulting difficulty in ambulation. On the basis of lack of response to other neuroleptics the patient was started on haloperidol l0 mg daily on 18 April 1973. Two days later, the patient developed prodromal symptoms of abdominal fullness. discomfort and constipation. with urinary retention. Haloperidol was therefore discontinued and her symptoms of retention disappeared. A full examination of urinary function proved to be entirely within normal limits as had been the previous laboratory examinations. Two days later. haloperidol was re-started in a dose of 10 mg

Discussion

The appearance of urinary retention during moderate to high dose butyrophenone therapy deserves mention. In the cases described, complete physical and laboratory examination did not disclose any organic pathology which might have contributed to the production of these symptoms. In both cases, the prodromal syndrome of abdominal fullness, distention and constipation heralded the appearance of urinary retention. At no time was there any evidence of paralytic ileus, and in both cases urinary retention disappeared after discontinuance or decrease in butyrophenone therapy. Therefore from the clinical evidence it would appear that there is causal relationship between the administration of butyrophenones and the appearance of gastrointestinal and urinary tract symptoms.
It cannot as yet be ascertained which mechanism was responsible for these untoward reactions, but several come to mind. According to Ban (1) haloperidol is practically devoid of autonomic side effects, but it is possible that the drug exerts an autonomic action, particularly on the trigone of the bladder and the sphincter, thus causing increased tonus and retention. Based on this hypothesis, an attempt was made to decrease the anticholinergic action of haloperidol by administering Carbachol, a cholinester. No appreciable diminution in symptoms was noted. Hence, the hypothesis that haloperidol exerted a parasympatholytic action is in considerable doubt. The likelihood of other drugs given during butyrophenone therapy causing untoward reaction was considered. In one of these cases, benztropine mesylate was used.

1. Ban, T. A.: Schizophrenia: A
Psychopharmacological Approach.
Springfield, 1II. Charles C. Thomas, p.
24, 1972.

2. Ban, T. A. and Lehmann, H. E.: Efficacy
of haloperidol in drug refractory
patients. lnt. J. Neuropsychiatry 3:
Suppl. 1: 78-86, 1967.

3. Chapel, J. L.: Gilles de ia Tourette's
disease. Can. Psychiatr. Assoc. J. 11:
4, 324-329, 1966.

4. Chapel, J. L., Brown, N. and Jenkins,
R. L. Tourette's disease -- symptomatic
relief with haloperidol. Ara. J.
Psychiatry 12: 608-610, 1964.

5. Linquist, R.: Clinical tests with
haldol in long-term schizophrenia and
acute manic states. Svensk. Lakatidin.
58: 1422-1429, 1961.