A naturalistic controlled study of relapsing schizophrenic patients with tardive dyskinesia and supersensitivity psychosis
Open accessAbstract
Despite advances in treatments, relapses in schizophrenia still occur. The causes of relapse are not always apparent, especially for patients that are compliant with medication. One possibility is that the brain adapts to long-term antipsychotic drug treatment, leading to tolerance and withdrawal symptoms. This has been described as supersensitivity psychosis. Tardive dyskinesia is also thought to occur as a consequence of dopamine supersensitivity caused by chronic treatment with antipsychotics. Another associated feature is sensitivity to life stress. This study investigated the relationship between abnormal movements, life events and drug treatment in patients relapsing on antipsychotics with high potency at the dopamine D2 receptor. Twenty-two patients from a cohort of 128 patients experiencing a psychotic relapse were assessed; of these, seven (32%) met criteria for the presence of abnormal involuntary movements. These subjects were found to be clinically distinct from the subjects without abnormal movements. They tended to be older with a greater duration of illness and higher dosage of antipsychotics but more symptoms of psychosis compared with the other subjects. Relapse was also associated with minor life events. The association between abnormal involuntary movements and high levels of psychotic symptoms suggests that dopamine sensitization/supersensitivity may underlie both phenomena. These results suggest that clinicians may have to consider alternative dosing strategies, novel agents or switching to one of the antipsychotics that have a lower affinity for the D2 receptor.
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The use of ketamine in psychiatry is at risk of replicating the 2016 opioid US epidemic abuse with the risk to induce neurotoxicity, which might be associated with persistent post-withdrawal disorders.
“In view of the inevitable decay of the response to ketamine due to pharmacological tolerance [148] and its possible benefit as maintenance therapy in treatment-resistant depression [142], and considering that some clinicians use ketamine formulations for chronic use despite the alarm regarding 'the rapid proliferation of off-label ketamine administration in the absence of evidence of”
From Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications (2020) · cites this paper as [149]
The Introduction (page not provided) discusses tolerance and withdrawal-related psychosis after long-term antipsychotic treatment in schizophrenia. Searches for ketamine, the opioid epidemic, and persistent post-withdrawal disorders found no passage addressing the claim about ketamine use in psychiatry. (LLM, conf=0.76)
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- Authors
- Fallon, P., & Dursun, S. M.
- Affiliations
- University of Manchester (GB)
- University of Alberta (CA)
- ORCID
- Dursun, Serdar M
- Venue
- Journal of Psychopharmacology
- Publisher
- SAGE Publications
- Published
- 2010-02-10
- Volume
- 25
- Issue
- 6
- Pages
- 755-762
- ISSN
- 0269-8811 (ISSN-L)
- 1461-7285
- OpenAlex
- W1999328412
- Cited by
- 56
- References
- 60
- Citations by year
- 2026: 1 · 2024: 2 · 2023: 2 · 2022: 1 · 2021: 4 · 2020: 6 · 2019: 2 · 2018: 1 · 2017: 4 · 2016: 5 · 2015: 8 · 2014: 4 · 2013: 9 · 2012: 4
- FWCI
- 3.49
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Psychopharmacology (publishedVersion)
- PubMed (publishedVersion)
- University of Salford Institutional Repository (University of Salford) (submittedVersion, cc-by)
- Funders
- National Institute for Health and Care Research (RDO/33/94)
- Deakin University
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- schizophrenia relapse, tardive dyskinesia, dopamine D2 receptor, dopamine sensitization, antipsychotic withdrawal, abnormal involuntary movements, life events, antipsychotic dosing, antipsychotic switching
- MeSH terms
- Adult, Age Factors, Dose-Response Relationship, Drug, Drug Tolerance, Female, Humans, Life Change Events, Male, Middle Aged, Movement Disorders, Recurrence, Schizophrenia, Sex Factors, Antipsychotic Agents, Cohort Studies
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