Anticholinergic drugs are frequently used in psychiatry for the prophylaxis and treatment of extrapiramidal symptoms caused by neuroleptics. Abuse of anticholinergic agents has been reported in patients with psychotic disorders, on treatment with neuroleptics, and polysubstance use disorders. We are reporting the case of a patient who presented with hypoactive delirium as a consequence of biperiden dependence. The clinician must pay special attention to detect anticholinergic misuse in patients presenting with delirium of unknown cause.

Aims. We have retrospectively analyzed the variations in the clinical profile of patients with a positive consumption of alcohol and/or drugs of abuse that have been confirmed and treated in the Emergency Department of a Virgen de La Arrixaca University Hospital in Murcia (Spain) after a period of 10 years. Secondly, we have assessed if the use of urine toxicology screen tests had any influence on the improvement of the management and/or referral of these patients to specialized services from the Emergency Department or at the time of discharge from hospital, regardless of the specialist or service where they had been treated. Method. 415 patients were selected in the year 2000 and 452 in the year 2010 who had tested positive for alcohol and drugs, assessing the reason for consultation, specific symptoms, drug used, record, diagnosis, and patient management. Results. The most frequent reasons for going to the Emergency Department was common illness, mainly psychiatric disorders, and the type of drug taken, alcohol. There were no significant differences between both groups, but approximately 50% of the patients were not referred for treatment of the abuse or dependency. Conclusions. The clinical profession should consider measures to improve detection and referral of patients with substance abuse disorders.