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Children's Mental Health Site of the Month

 

 

 

Supersensitivity Psychosis 

I recently pulled some cases regarding supersensitivity psychosis off of PubMed (this is antipsychotic drug-induced psychosis), only to find that Vera Hassner Sharav has already done a beautiful job of very thoroughly documenting this on the madnation web site.  Here is a sampling, for those of you who may not have seen this page yet - please go to the web site to see the whole thing, which is much longer and includes data on movement disorders as well:

http://www.madnation.org/citations/circarebib.htm

Behavioral toxicity of antipsychotic drugs.

J Clin Psychiatry 1987 Sep;48 Suppl:13-9

Extrapyramidal symptoms cause much misery, often go undiagnosed, and can interfere with treatment and rehabilitation. Akinesia is a behavioral state of diminished motoric and psychic spontaneity that is difficult to distinguish from the negative symptoms of schizophrenia. The most useful clinical correlates of akinesia are a subjective sense of sedation and excessive sleeping. Akinesia interferes with social adjustment and may manifest as "postpsychotic depression." The subjective restlessness of akathisia is usually accompanied by telltale foot movements: rocking from foot to foot while standing or walking on the spot. Akathisia is strongly associated with depression and dysphoric responses to neuroleptics and has even been linked to suicidal and homicidal behavior in extreme cases.

Kirkpatrick B, Alphs L, Buchanan RW (1992)

The concept of supersensitivity psychosis.

J Nerv Ment Dis 1992 Apr;180(4):265-70

Maryland Psychiatric Research Center, Department of Psychiatry,

University of Maryland

School of Medicine, Baltimore 21228.

ABSTRACT: The hypothesis that chronic neuroleptic treatment may induce relapse in some schizophrenic patients has received considerable attention. This effect, usually called supersensitivity psychosis, has been attributed to neuroleptic-induced changes in mesolimbic or mesocortical dopaminergic receptors. However, research has not established that neuroleptics cause the proposed effect, and considerations of mechanism have not been separated from those of causation. The focus of research in this area should be the establishment or refutation of a causal relationship between chronic neuroleptic use and psychotic relapse. 

Publication Types: Review Review, tutorial

Chouinard G, Sultan S

Treatment of supersensitivity psychosis with antiepileptic drugs: report of a series of 43 cases.

Psychopharmacol Bull 1990;26(3):337-41

Allan Memorial Institute, Montreal, Quebec, Canada.

Supersensitivity psychosis has emerged as a potential side effect of long-term neuroleptic therapy that may be similar to tardive dyskinesia.

Schizophrenic patients with supersensitivity psychosis and considered to be drug-resistant were treated with anti-epileptic medication.

Forty-three separate trials were conducted on a total of 35 patients.

Over half improved on clinical global impression, some of them considerably. We propose that antiepileptic drugs ameliorate supersensitivity psychosis and so-called "drug-resistant" schizophrenic patients by correcting a pharmacological kindling effect in the limbic system which results from chronic neuroleptic therapy. 

Publication Types: Clinical trial

Kahne GJ

Rebound psychoses following the discontinuation of a high potency neuroleptic.

Can J Psychiatry 1989 Apr;34(3):227-9

Increased familiarity with the effects of psychotropic medications has led to modifications in both prescribing habits and length of treatment.

The case of a 34 year old woman is presented, in whom the return of psychotic symptoms following the discontinuation of neuroleptic medications is attributed to a rebound phenomena as opposed to a relapse of an underlying chronic illness

The author cites parallel situations previously described in the medical literature and outlines a conceptual framework for the understanding of this phenomenon.

Bowers MB Jr, Swigar ME

Psychotic patients who become worse on neuroleptics.

J Clin Psychopharmacol 1988 Dec;8(6):417-21

Yale University School of Medicine, Department of Psychiatry, New Haven, Connecticut

ABSTRACT: We describe a group of psychotic patients who became worse early in the course of neuroleptic treatment. Characteristics of this group were: predominantly female sex, relatively brief onset, family history of affective disorder, hypomotoric presentation, and severe neuroleptic side effects. We propose that some patients with affective psychoses are uniquely susceptible to profound blockade of the nigrostriatal dopaminergic system by neuroleptics.

During the last decade ("Decade of the Brain"), newer "atypical" neuroleptics have been developed-clozapine, risperdone, olanzapine and quitepane-these drugs have a lower risk of EPS and TD, but are associated in varying degrees with sedation, cardiovascular and liver enzyme abnormalities, anticholinergic effects, extreme weight gain (30lbs to 50lbs) which significantly increases the risk for diabetes, sexual dysfunction, NMS, seizures, mania, and (in the case of clozapine) agranulocytosis.

Additionally, mounting clinical evidence and findings -from non-industry sponsored research-point to additional, severe, adverse neurological changes in response to long-term exposure to neuroleptics. These drugs' actions suppress certain brain receptors (e.g., dopamine, glutamate), and when such drugs are withdrawn (or a patient stops taking them) the drug-induced receptor changes are unmasked, causing an acute "discontinuation syndrome" (i.e., "rebound psychosis" ) that is often more severe than the original symptoms of the illness. Psychotic relapse can cause months of mental and emotional anguish and loss of functioning-rebound psychosis can cause violent and suicidal behavior in patients not previously violent. [Often, these drug-induced reactions are used to justify forcing the person back on the drugs.]

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