CoChat
Sign Up
Cited by 168Schizophrenia research and treatmentTreatment of Major DepressionElectroconvulsive Therapy Studies

Atypical Antipsychotics: CATIE Study, Drug-Induced Movement Disorder and Resulting Iatrogenic Psychiatric-Like Symptoms, Supersensitivity Rebound Psychosis and Withdrawal Discontinuation Syndromes

Chouinard, Guy, Chouinard, Virginie-Anne·2008·Psychotherapy and Psychosomatics
DOI 10.1159/000112883
Open this paper in CoChat — free account

Abstract

Chronic illness can result in chronicity of clinical practice. As we have moved away from prescribing classical antipsychotics and tricyclic antidepressants, issues remain with the use of atypical antipsychotics and second-generation antidepressants that need to be addressed, namely, iatrogenic discontinuation syndromes and supersensitivity psychiatric symptoms. An optimal maintenance drug treatment consists of regular attempts to reduce the dose by finding a minimal therapeutic dose, regularly asking the question of when to reduce or withdraw treatment and for which patients, and moreover, why it is difficult to decrease a given drug treatment. Recently, Falloon [1] proposed that maintenance pharmacotherapy in schizophrenia will depend on finally finding minimally effective doses through ‘extensive training in stress management’. In the long-term treatment of major depression, Fava [2] has hypothesized that antidepressants can aggravate the course of depressive illness. Lambert [3] recently suggested that ‘antipsychotic-switching syndromes’, which include discontinuation syndromes, are a ‘major barrier’ to adjusting antipsychotic treatment. In this paper, we propose that to achieve optimal maintenance treatment with antipsychotics, and to reduce or withdraw antipsychotics effectively, we must distinguish syndromes associated with discontinuing antipsychotics, such as supersensitivity psychosis, from true relapse. While the prevalence and incidence of drug-induced movement disorder(s) (DIMD) has continuously decreased with atypical antipsychotics, DIMD persist as do psychiatric and psychiatric-like symptoms associated with DIMD, and these must also be identified and evaluated. Persistent DIMD have been found to be a predictor of the later emergence of tardive dyskinesia (TD) and supersensitivity psychosis [4]. At present, we need to determine the relative risk of iatrogenic discontinuation syndromes, DIMD and DIMD psychiatric symptoms resulting from atypical antipsychotics.Although atypical antipsychotics are now most commonly prescribed, a debate has emerged on the differences between classical and atypical antipsychotics following the results of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study [5]. The question that comes to the forefront is why recent studies are no longer finding well-established differences between these two generations in terms of efficacy and DIMD. Reasons to explain why recent schizophrenia studies have found reduced drug and placebo differences were examined at the International Society for CNS Clinical Trials and Methodology Annual Mid-Year Conference [6]. While the fact must be considered that patients included in recent studies have less severe illness with symptoms that are better controlled than in past studies (likely due to earlier treatment), the issue that psychiatric symptoms specific to schizophrenia are not being adequately measured nor differentiated from psychiatric and psychiatric-like symptoms associated with DIMD is crucial to answering this question. For example, it is hard to believe that in a recent review of psychomotor slowing in schizophrenia, the authors, when evaluating its effect on measurement and treatment research to improve cognition in schizophrenia (MATRICS), nearly completely ignored the influence of akinesia and DIMD on neuropsychological tests in schizophrenia and the importance of accurate DIMD measurements [7]. As we pursue this ongoing discussion, we recommend the discontinuation of all classical antipsychotics due to their neurotoxic association with a high prevalence of DIMD and increases in basal ganglia volumes [8], and now address how to prescribe atypical antipsychotics most effectively, by taking into account DIMD-associated psychiatric symptoms and iatrogenic discontinuation syndromes.The first widely prescribed atypical antipsychotic, risperidone, was first approved in Canada in 1993 following the publication of the Canadian Multicenter Risperidone Study, which reported clear advantages of risperidone over haloperidol and the placebo, and significantly less appearance of DIMD with risperidone than haloperidol [9]. DIMD includes the 4 types of movement disorders induced by antipsychotics: parkinsonism, dystonia, dyskinesia and akathisia [10]. These findings were confirmed by the American Risperidone Study [11] and several other studies reporting greater efficacy of risperidone over classical antipsychotics in terms of cost-efficiency [12] and the clinical management of patients with schizophrenia [13,14,15,16,17]. However, the CATIE study [5] challenged these results. The CATIE study found that of the 4 atypical antipsychotics studied, olanzapine was the only atypical to be more efficacious than the classical antipsychotic perphenazine, and to be highly superior to risperidone for discontinuation of treatment, due to lack of efficacy [5]. Olanzapine is known to produce less DIMD compared to risperidone, ther

Integrity signals

Registry

Crossref · 10.1159/000112883

Cites

87 of 87 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • New withdrawal symptoms are usually the same and common to all psychotropic medications during withdrawal, but also specific and unique for a drug class.

    “New symptoms are usually the same, common to all psychotropic medications during withdrawal [12, 15, 23] (e.g., nausea, headaches, sleep disturbances) [10], but also specific and unique for a drug class (e.g., specific serotonin-related symptoms: flu-like symptoms, diarrhea, confusion) [10].”

    From Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications (2020) · cites this paper as [12]

  • New withdrawal symptoms are common to all CNS drugs, including opioids, barbiturates, alcohol, antidepressants, antipsychotics, and benzodiazepines.

    “They are common to all CNS drugs, including opioids, barbiturates, alcohol, antidepressants, antipsychotics, and benzodiazepines [5,10,11] .”

    From New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal (2015) · cites this paper as [5]

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Chouinard, G., & Chouinard, V.-A.
Affiliations
Institut universitaire en santé mentale de Montréal (CA)
ORCID
Chouinard, Virginie-Anne
Venue
Psychotherapy and Psychosomatics
Publisher
S. Karger AG
Published
2008
Volume
77
Issue
2
Pages
69-77
ISSN
  • 0033-3190 (ISSN-L)
  • 1423-0348
DOI
10.1159/000112883
OpenAlex
W2032248619
Cited by
168
References
87
Citations by year
2026: 4 · 2025: 7 · 2024: 1 · 2023: 8 · 2022: 12 · 2021: 19 · 2020: 8 · 2019: 15 · 2018: 14 · 2017: 8 · 2016: 7 · 2015: 12 · 2014: 4 · 2013: 14 · 2012: 9
FWCI
5.84
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Psychotherapy and Psychosomatics (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
Keywords
drug-induced movement disorders, tardive dyskinesia, discontinuation syndrome, maintenance pharmacotherapy, schizophrenia, major depressive disorder, antidepressant discontinuation, minimum effective dose, CATIE study, antipsychotic switching, relapse, dose reduction, classical antipsychotics, second-generation antidepressants
MeSH terms
Mental Disorders, Chronic Disease, Humans, Iatrogenic Disease, Psychoses, Substance-Induced, Substance Withdrawal Syndrome, Antipsychotic Agents, Incidence, Prevalence, Akathisia, Drug-Induced

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review