An analysis of case records of admissions to a ward specialising in the assessment and treatment of predomi

Belladonna alkaloids have been prized for centuries for their mind-altering qualities (Shader & Greenblatt, 1971), and the toxic state resulting from poisoning with these alkaloids was well recognised. Christison (1845) described the leading symptoms as “¿ dryness in the throat, then delirium with dilated pupils and after wards coma―.The delirium he noted to be “¿ generally extravagant and most commonly of the pleasing kind sometimes accompanied with immoderate and uncon trolled laughter, sometimes with constant talking, but occasionally with loss of voice and a state of mind resembling somnambulism―. The synthetic high-po tency analogues of belladonna alkaloids share their psycho-activity; since the abuse potential of bella donna was well recognised, the abuse of synthetic anticholinergics is not to be wondered at. Perhaps the only surprise is that its general recognition has taken so long, particularly given the frequency with which these agents are exhibited in everyday clinical practice by most psychiatrists. Benzhexol hydrochloride (trihexyphenidyl), a po tent anticholinergic agent (Stephens, 1967), has gained widespread use in the treatment of Parkinson's disease and in the control of drug-induced extrapyramidal side-effects. Despite early reports (Bolin, 1960; Bachrich, 1964; Stephens, 1967) drawing attention to its psychoactivity and potential, at least in theory, for abuse, this does not appear to have been recognised in clinical practice until recently. In the last few years, reports emphasising its euphorogenic abuse and anxiolytic quality have been published (Kaminer eta!, 1982; Mohan et a!, 1981 ; Goggin & Solomon, 1979; MacVicar, 1977), but to date, the only series of case reports of any size is in Polish (Jakubczyk et a!, 1972). Abuse of benzhexol has been noted with increasing frequency in recent years amongst the disaffected and disadvantaged youths attending psychiatric clinics, who reported that their use of the drug was motivated by its hallucinogenic and euphorogenic properties. The failure by the medical profession to recognise its potential for abuse resulted in a situation where prescriptions for large quantities could be obtained without difficulty. This study was undertaken in an attempt to identify the characteristics of this group of benzhexol abusers.