A naturalistic controlled study of relapsing schizophrenic patients with tardive dyskinesia and supersensitivity psychosis. 2011

Paul Fallon, and Serdar M Dursun
Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK. paul.fallon@gmw.nhs.uk

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.

UI MeSH Term Description Entries
D008016 Life Change Events Those occurrences, including social, psychological, and environmental, which require an adjustment or effect a change in an individual's pattern of living. Life Course,Life Crises,Life Crisis,Life Experiences,Course, Life,Crisis, Life,Event, Life Change,Experience, Life,Life Change Event,Life Courses,Life Experience
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009069 Movement Disorders Syndromes which feature DYSKINESIAS as a cardinal manifestation of the disease process. Included in this category are degenerative, hereditary, post-infectious, medication-induced, post-inflammatory, and post-traumatic conditions. Dyskinesia Syndromes,Etat Marbre,Status Marmoratus,Movement Disorder Syndromes,Dyskinesia Syndrome,Movement Disorder,Movement Disorder Syndrome
D012008 Recurrence The return of a sign, symptom, or disease after a remission. Recrudescence,Relapse,Recrudescences,Recurrences,Relapses
D004305 Dose-Response Relationship, Drug The relationship between the dose of an administered drug and the response of the organism to the drug. Dose Response Relationship, Drug,Dose-Response Relationships, Drug,Drug Dose-Response Relationship,Drug Dose-Response Relationships,Relationship, Drug Dose-Response,Relationships, Drug Dose-Response
D004361 Drug Tolerance Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from DRUG RESISTANCE wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from MAXIMUM TOLERATED DOSE and NO-OBSERVED-ADVERSE-EFFECT LEVEL. Drug Tolerances,Tolerance, Drug,Tolerances, Drug
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults

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