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March 31, 2015 by Tomotaka Suzuki et al | Psychiatry Research

Dopamine supersensitivity psychosis as a pivotal factor in treatment-resistant schizophrenia

Highlights

  • Dopamine supersensitivity psychosis (DSP) in schizophrenia is characterized by unstable psychosis and/or tardive dyskinesia (TD).
  • The development of DSP is promoted by long-term antipsychotic treatment.
  • We investigated the role of DSP in treatment-resistant schizophrenia (TRS) which shows both a lesser response to and intolerance to pharmacotherapy.
  • Approximately 70% of the patients in our TRS cohort had experienced at least a single DSP episode at some point during treatment.
  • This finding strongly suggests that these DSP may play an important role in the process leading to treatment refractoriness in schizophrenia.

Abstract

There may be subtypes in treatment-resistant schizophrenia (TRS), and one of the subtypes may be related to dopamine supersensitivity psychosis (DSP). In developing strategies for prevention and treatment TRS, it is important to clarify the role of DSP in TRS. TRS patients were recruited from 3 hospitals for the present study. Through chart reviews, all patients were judged as either TRS or not, and then possible TRS patients were investigated about their past/present histories of DSP episode(s) by direct interviews. We then compared each factor between the groups with and without DSP episode(s). Out of 611 patients screened, 147 patients met the criteria for TRS and were included in the present analysis. These were divided into groups with and without DSP, comprising 106 (72.1%) and 41 patients (27.9%), respectively. Clinical characteristics in the two groups were similar, except for drug-induced movement disorders (DIMDs), which were significantly more important in DSP patients. Of the DSP patients, 42% and 56% experienced rebound psychosis and tolerance to antipsychotic effects, respectively. The present study revealed that approximately 70% of TRS patients experienced one or more DSP episodes, which may have a strong impact on the long-term prognosis of patients with schizophrenia.

 

DOI: http://dx.doi.org/10.1016/j.psychres.2015.02.021

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July 2, 2013 by JAMA | Lex Wunderink, MD, PhD, et al

First-Episode Psychosis Not a Life Sentence of Psychotropic Medication Use

Jama journalRecovery in Remitted First-Episode Psychosis at 7 Years of Follow-up of an Early Dose Reduction/Discontinuation or Maintenance Treatment Strategy Long-term Follow-up of a 2-Year Randomized Clinical Trial

ABSTRACT

Importance Short-term outcome studies of antipsychotic dose-reduction/discontinuation strategies in patients with remitted first-episode psychosis (FEP) showed higher relapse rates but no other disadvantages compared with maintenance treatment; however, long-term effects on recovery have not been studied before.

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June 11, 2013 by Bob Nikkel, MSW

Canadian Provider Association Publishes Guide to Reducing Antipsychotic Use

An interesting thing has been happening in Canada. In late 2011, the British Columbia Ministry of Health issued a report entitled, “A Review of the Use of Antipsychotic Drugs in British Columbia Residential Care Facilities.” The family of a senior living in such a facility raised the issue of over-medication and, instead of reacting defensively, the provincial government set about studying the prescribing practices of physicians in these residential programs.

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December 3, 2012 by Sandra Steingard, MD

A Recent Study of Atypical Neuroleptics: “The Results of our Study are Sobering”

Sandra-SteingardThe major outcome of a recently published study of the four most commonly prescribed neurolpetics was that these drugs were not found to be effective or safe.

This important study, co-authored by Dilip Jeste the current president of the American Psychiatric Association, is worth reviewing in greater detail.

The study was modeled to capture clinical practice.  Entry to the study was broad and not limited to a specific diagnostic category.

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