Anticholinergic agents have multiple CNS effects, even when used in therapeutic doses. These can include sedation, amnesia, delirium and, in rare cases, psychosis. While there is some symptom overlap between delirium and psychosis, psychotic patients will have a clear sensorium. We present the case of a 59-year-old male who became psychotic and required hospitalization after the administration of a large anticholinergic load from a smoking cessation clinic. We will review the literature regarding previous cases of anticholinergic medication induced psychosis, discuss treatment options and review the clinical effects of anticholinergic medications.
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