Antipsychotic-induced supersensitivity – A reappraisal

2021 ◽  
pp. 000486742110256
Author(s):  
William Lugg
Keyword(s):  
Tardive Dyskinesia ◽  
Significant Proportion ◽  
Underlying Mechanism ◽  
Antipsychotic Treatment ◽  
Physiological Changes ◽  
Antipsychotic Therapy ◽  
Neurotransmitter Systems ◽  
Potential Benefits ◽  
Treatment Refractory ◽  
Brain Pathways

Objectives: Tardive dyskinesia, psychotic relapse and treatment-refractory psychosis have long been associated. A common underlying mechanism involving antipsychotic-induced ‘supersensitivity’, albeit in different brain pathways, was proposed as early as 1978. This piece seeks to reappraise the concept and potential implications of antipsychotic-induced supersensitivity. Conclusions: Evidence increasingly suggests that chronic antipsychotic exposure induces neuroadaptive physiological changes in dopaminergic, and other, neurotransmitter systems that may render some individuals more vulnerable to psychotic relapse - including those receiving continuous antipsychotic treatment. It is possible that in treating every episode of psychosis with prolonged or indefinite antipsychotic therapy, we paradoxically increase the risk of psychotic relapse in a significant proportion of people. A greater appreciation of supersensitivity may allow us to optimise any potential benefits of antipsychotics while minimising the risk of inadvertent iatrogenic harms. More research is needed to improve our understanding of the underlying neurophysiology of supersensitivity and to better identify which individuals are most vulnerable to its development. It is time we paid more attention to the concept, emerging evidence and potential implications of antipsychotic-induced supersensitivity and, where appropriate, adjusted our practice accordingly.

scholarly journals CLINICAL AND SOCIAL RISK FACTORS OF TARDIVE DYSKINESIA IN PATIENTS WITH SCHIZOPHRENIA DURING ANTIPSYCHOTIC TREATMENT

2015 ◽  
Vol 14 (1) ◽  
pp. 32-39
Author(s):  
Ye. G. Kornetova ◽  
A. V. Semke ◽  
Ye. G. Dmitrieva ◽  
Yu. N. Borodyuk ◽  
A. S. Boyko
Keyword(s):  
Risk Factors ◽  
Tardive Dyskinesia ◽  
Negative Symptoms ◽  
Psychiatric Treatment ◽  
Involuntary Movement ◽  
Antipsychotic Treatment ◽  
Social Risk ◽  
Social Risk Factors ◽  
Dynamic Features ◽  
Antipsychotic Therapy

The purpose of the present work was to study the clinical features and risk factors of tardive dyskinesia among     the     schizophrenia     patients     who     durably     receive     the     antipsychotic     therapy. 180 of the 18 to 65 age bracket schizophrenia patients, who were treated in a residential psychiatric treatment facility, were examined with the use of the Positive and Negative Syndrome Scale (PANSS), Abnormal Involuntary Movement Scale (AIMS), and the basic chart of formalized sociodemographic and clinico-dynamic features developed at the Tomsk Mental Health Research Institute. The acquired data were processed by the Mann–Whitney U-Test and χ2. The average age of the tardive dyskinesia patients  turned out to be conclusively older than that of the patients without this derangement. People who have tardive dyskinesia statistically often happen to be single in comparison with other variants of marital status. It was found out that women happen to have tardive dyskinesia more often, which allows us to see the female gender as a risk factor. The tardive dyskinesia patients had certain negative symptoms. The patients were arranged into groups according to the prepotency of symptom-complexes over the subgroups: with orofacial, thoracolumbar and combined tardive dyskinesia. The average age of the orofacial dyskinesia patients turned out to be conclusively older than that of the patients without tardive dyskinesia. The negative symptoms level in the subgroup was conclusively higher than among those without tardive dyskinesia. The average age of the thoracolumbar dyskinesia patients was conclusively older than that of the patients without tardive dyskinesia. The average age of the combined dyskinesia patients was conclusively older than the patients without the tardive dyskinesia. The patients having schizophrenia for longer than 10 years prevailed in the combined dyskinesia group. Such characteristics as education level and social status, age of when the medical problem started, dominance of the positive symptoms, duration of antipsychotic agents administration, somatic condition, use of psychoactive substances, suicidal and hetero-aggressive behaviors make no contribution to the risk of tardive dyskinesia development in the presence of schizophrenia, and they are not protective factors either.

scholarly journals Tardive Dyskinesia in the Era of Typical and Atypical Antipsychotics. Part 2: Incidence and Management Strategies in Patients with Schizophrenia

2005 ◽  
Vol 50 (11) ◽  
pp. 703-714 ◽  
Author(s):  
Howard C Margolese ◽  
Guy Chouinard ◽  
Theodore T Kolivakis ◽  
Linda Beauclair ◽  
Robert Miller ◽  
...  
Keyword(s):  
Adverse Effect ◽  
Tardive Dyskinesia ◽  
Atypical Antipsychotics ◽  
De Novo ◽  
Management Strategies ◽  
Antipsychotic Agents ◽  
Antipsychotic Treatment ◽  
Antipsychotic Therapy ◽  
Conventional Antipsychotic

Objective: Tardive dyskinesia (TD), the principal adverse effect of long-term conventional antipsychotic treatment, can be debilitating and, in many cases, persistent. We sought to explore the incidence and management of TD in the era of atypical antipsychotics because it remains an important iatrogenic adverse effect. Methods: We conducted a review of TD incidence and management literature from January 1, 1965, to January 31, 2004, using the terms tardive dyskinesia, management, therapy, neuroleptics, antipsychotics, clozapine, olanzapine, risperidone, quetiapine, ziprasidone, and aripiprazole. Additional articles were obtained by searching the bibliographies of relevant references. We considered articles that contributed to the current understanding of both the incidence of TD with atypical antipsychotics and management strategies for TD. Results: The incidence of TD is significantly lower with atypical, compared with typical, antipsychotics, but cases of de novo TD have been identified. Evidence suggests that atypical antipsychotic therapy ameliorates long-standing TD. This paper outlines management strategies for TD in patients with schizophrenia. Conclusion: The literature supports the recommendation that atypical antipsychotics should be the first antipsychotics used in patients who have experienced TD as a result of treatment with conventional antipsychotic agents. The other management strategies discussed may prove useful in certain patients.

Antipsychotic-induced tardive dyskinesia: The role of glutamatergic system

2016 ◽  
Vol 33 (S1) ◽  
pp. S97-S97
Author(s):  
A. Boiko ◽  
S. Ivanova ◽  
A. Semke
Keyword(s):  
Tardive Dyskinesia ◽  
Glutamate Transporter ◽  
Antipsychotic Treatment ◽  
Nucleotide Polymorphisms ◽  
Antipsychotic Therapy ◽  
Drug Induced ◽  
Schizophrenic Patients ◽  
Competing Interest

Tardive dyskinesia (TD) occurs in 20–25% of patients with long-term antipsychotic therapy. Abnormalities in glutamatergic transmission are considered one of the key components of the pathogenesis of drug-induced side effects. Glutamate acts as excitotoxin under certain conditions and in excessive concentrations.Aim is to study the concentration of glutamate and analysis of single nucleotide polymorphisms (SNP) in genes coding the glutamate transporter and NMDA-receptors in schizophrenic patients with TD and without it.The study group included 156 patients with schizophrenia receiving long-term antipsychotic treatment. Patients were divided into two groups: 63 patients with TD and 93 patients without it. Glutamate was determined in serum by spectrophotometric method. Determination of allelic variants of gene SLC1A2 (rs4354668) and GRIN2A (rs2650427, rs1969060) was performed by polymerase chain reaction in real-time.We found a significant (P < 0.05) increase of the concentration of glutamate in patients with TD. Significant (P < 0.05) reduction in frequency of genotype GG of GRIN2A (rs1969060) and TT of SLC1A2 (rs4354668) were found in patients with TD in comparison to group without TD. In the study of glutamate concentration depending on the genotype GRIN2A (rs1969060) and genotype SLC1A2 (rs4354668) we observed a statistically significant change: elevated levels of glutamic acid identified with the heterozygous genotype in patients.It is possible to suggest that reduction in frequency of these genotypes increases the risk of movement disorders due to the protective effect of these genotypes.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Treatment-resistant schizophrenia characterised by dopamine supersensitivity psychosis and efficacy of asenapine

2021 ◽  
Vol 14 (4) ◽  
pp. e242495
Author(s):  
Nagara Takao ◽  
Toshiya Murai ◽  
Hironobu Fujiwara
Keyword(s):  
Animal Studies ◽  
Significant Proportion ◽  
Antipsychotic Treatment ◽  
High Dose ◽  
Receptor Density ◽  
Treatment Resistant ◽  
Psychomotor Activity ◽  
Receptor Blockers ◽  
Dopamine Supersensitivity

Dopamine supersensitivity psychosis (DSP) frequently arises with long-term antipsychotic treatment and accounts for a significant proportion of treatment-resistant schizophrenia. The mechanism underlying DSP is thought to be a compensatory increase in dopamine receptor density in the striatum caused by long-term antipsychotic treatment. Previous animal studies have reported that antipsychotics increase serotonin 5-HT2A receptor density in the striatum and that 5-HT2A receptor blockers suppress dopamine-sensitive psychomotor activity, which may be linked to the pathophysiology of DSP. In this paper, we describe a patient who was hospitalised with treatment-resistant schizophrenia. Following treatment with high-dose antipsychotic polypharmacy for 10 weeks, the patient experienced worsening of psychotic and extrapyramidal symptoms. The patient was then started on second-generation antipsychotic asenapine while other antipsychotics were tapered off, resulting in improvement of these symptoms. Retrospectively, we presumed that the high-dose antipsychotic polypharmacy caused DSP, which was effectively treated by the potent 5-HT2A receptor antagonism of asenapine.

Tardive Dyskinesia: Outcome of Antipsychotic Treatment and Brain Damage?

2014 ◽  
pp. 2315-2326 ◽  
Author(s):  
Richard M. Kostrzewa ◽  
John P. Kostrzewa ◽  
Ryszard Brus
Keyword(s):  
Tardive Dyskinesia ◽  
Brain Damage ◽  
Antipsychotic Treatment

scholarly journals Abnormalities in Glucose Blood Level during Antipsychotic Treatment in Schizophrenia Patients

2021 ◽  
Vol 9 (T3) ◽  
pp. 340-344
Author(s):  
Faisal Idrus ◽  
Theodorus Singara ◽  
Dwiwahyu Sunarto ◽  
Saidah Syamsuddin ◽  
Sonny T. Lisal
Keyword(s):  
Side Effects ◽  
Blood Sugar ◽  
Blood Sugar Level ◽  
Fasting Blood Glucose ◽  
Antipsychotic Treatment ◽  
Antipsychotic Therapy ◽  
Potential Health ◽  
Sugar Levels ◽  
Risperidone Group ◽  
Haloperidol Group

Background: Schizophrenia is one of the mental disorder with many problematic issues, in both psychologically and socially. This disease requires provision of long-term antipsychotic therapy, hence could rise other potential health problems. Antipsychotic treatment can cause serious glucometabolic side-effects, including type 2 diabetes and hyperglycemic emergency. Recent attention has also been focused on antipsychotic-induced hyperglycemic emergencies experienced by new users of typical and atypical antipsychotic. Patients treated with atypical APDs have ~10 times higher risk in developing hyperglycaemic emergencies. In our pre-eliminary study, hyperglycemia condition in new patients occurs in four  in seven patients who received typical and atypical antipsychotics. This condition is often overlooked and is not routinely evaluated. Moreover, it can develop into diabetes and increase the risk of morbidity and mortality in schizophrenia patients. In this study, we would like to determine the acute effects of metabolic (hyperglycemia) in patients treated with antipsychotic (Risperidone and Haloperidol) Measurement of blood sugar levels was performed in groups treated with haloperidol (N = 15) and treated with risperidone (N = 15). Plasma samples were taken at the beginning of treatment, in week IV, and in week VIII. The measurement of glucose levels was performed after meal and in early morning before breakfast (fasting blood glucose level 8 hours). Results: The blood sugar level after meals was significantly higher in the Risperidone group compared to the Haloperidol group  (p <0.001) after IV and VIII weeks. Meanwhile, the fasting blood sugar level was significantly higher in the Risperidone group compared to the Haloperidol group after VIII weeks of treatment ( p <0.001). Conclusions: Both antipsychotics can cause an increase in blood sugar levels. Treatment with Risperidone significantly increased the blood sugar levels compared to treatment with haloperidol. Measurement of blood sugar level is needed to monitor the metabolic effect of antipsychotic, especially in patients treated with Risperidone. It is necessary to have dietary regulation and physical activities to prevent undesired metabolic side effects.

scholarly journals Use of Antipsychotics in Dementia Patients: A Descriptive Study

2020 ◽  
Vol 1 (4) ◽  
pp. 9-19
Author(s):  
Ziske Maritska ◽  
Muhammad Hilal Atthariq Ramadhan ◽  
Bintang Arroyantri Prananjaya
Keyword(s):  
Antipsychotic Drug ◽  
Cognitive Abilities ◽  
Secondary Data ◽  
Descriptive Study ◽  
Antipsychotic Treatment ◽  
Dopamine Antagonist ◽  
Elderly Age ◽  
Antipsychotic Therapy ◽  
Behavioural Symptoms ◽  
Dementia Patients

ABSTRACT Introduction. Dementia is a chronic progressive syndrome in which there is a decrease in the function of cognitive abilities including memory impairment, thinking ability, orientation, understanding, calculation, language, and assessment but without impaired consciousness. Apart from cognitive impairment, dementia is often accompanied by psychological symptoms and behavioural symptoms so that antipsychotic therapy is needed to overcome this. This study aims to identify the description of the use of antipsychotics in patients with dementia at Dr Mohammad Hoesin Palembang in the period 1 January 2014-31 December 2018. Methods. This research was a descriptive study using secondary data in the form of medical records of dementia patients receiving antipsychotic therapy at Dr Mohammad Hoesin General Hospital, Palembang. Samples were taken using a total sampling method. Results. There were 29 dementia patients (38.67%) receiving antipsychotic therapy. Most of the dementia patients who received antipsychotic therapy were in the late elderly age (27.59%) and were female (55.17%). The most commonly administered antipsychotic drug is haloperidol from the dopamine receptor antagonist (60%) with the most frequent dose of 0.5 mg (34.48%). Risperidone from the serotonin-dopamine antagonist class is the second most frequently prescribed antipsychotic drug (34.28%) at a dose of 1 mg (17.28%). The mean of haloperidol was 425 days, and risperidone was 295.5 days. Conclusion. Although in theory, psychological and behavioural symptoms are often found in dementia cases, not all dementia patients in RSUP Dr Mohammad Hoesin Palembang received antipsychotic therapy. People living with dementia who receive antipsychotic treatment get various types of drugs, dosages, and frequencies.

scholarly journals Concentrations of Thyroid Axis Hormones in Psychotic Patients on Hospital Admission: the Effects of Prior Drug Use

Medicina ◽  
2012 ◽  
Vol 48 (5) ◽  
pp. 33 ◽  
Author(s):  
Vesta Steiblienė ◽  
Narseta Mickuvienė ◽  
Arthur Prange ◽  
Robertas Bunevičius
Keyword(s):  
Drug Use ◽  
Hospital Admission ◽  
Rating Scale ◽  
Venous Blood ◽  
Significant Proportion ◽  
Sex Hormone Binding Globulin ◽  
Antipsychotic Treatment ◽  
Thyroid Disorder ◽  
General Group ◽  
Thyroid Axis

The aim of this study was to determine the concentrations of thyroid axis hormones in psychotic patients on hospital admission and to search for the associations between the concentrations of these hormones and prior drug use as well as mental symptoms. Material and Methods. Psychiatric diagnoses, psychotropic drug use, and the severity of psychoses were evaluated using the standard methods on admission. Venous blood from patients and healthy controls was drawn for the analysis of free thyroxin (FT4), free triiodothyronine (FT3), thyroid-stimulating hormone (TSH), and sex hormone-binding globulin (SHBG) concentrations. Results. Eighty-one psychotic patients, free of a thyroid disorder, were enrolled into the study. Compared with the controls, they displayed the higher FT4 concentrations in the general group (P=0.003) and the higher SHBG concentrations only in men (P=0.013). The FT4 concentration was higher in the patients who were not taking an antipsychotic drug on admission (P=0.039). No significant correlation was found between the severity of psychosis and concentrations of thyroid axis hormones. However, the FT3 concentration in the general group and TSH concentration in women correlated with the factor of the Brief Psychiatric Rating Scale expressing elevated mood. Conclusions. Our study confirms the higher FT4 concentrations in a significant proportion of acute psychotic patients. The concentrations of thyroid axis hormones were found to be associated with prior antipsychotic treatment on hospital admission.

Exploring law enforcement and public health as a collective impact initiative: lessons learned from Tasmania as a case study

2017 ◽  
Vol 3 (2) ◽  
pp. 79-92 ◽  
Author(s):  
Roberta Julian ◽  
Isabelle Bartkowiak-Théron ◽  
Jackie Hallam ◽  
Clarissa Hughes
Keyword(s):  
Public Health ◽  
Law Enforcement ◽  
Significant Proportion ◽  
State Level ◽  
Lessons Learned ◽  
Collective Impact ◽  
Impact Model ◽  
Content Type ◽  
Mapping Process ◽  
Potential Benefits

Purpose The purpose of this paper is to examine the potential benefits as well as some of the practical barriers to the implementation of a collective impact initiative in law enforcement and public health (LEPH) in Tasmania, Australia. Design/methodology/approach The paper is based on a review of programs, agencies and initiatives that are at the intersection of LEPH in Tasmania, through an analysis of the findings in evaluation reports, and the views of practitioners identified at a workshop on LEPH held at a national AOD conference and facilitated by the authors. Findings The strengths of collective impact initiatives, particularly in LEPH, are presented and some weaknesses identified. Some major obstacles to the consolidation of LEPH initiatives include siloed ways of working and budgets, lack of leadership and political will. Some progress has been made in addressing these weaknesses, although addressing complex social problems by moving beyond inter-agency collaboration toward an integrated model of service provision remains challenging. Practical implications The authors argue that there are practical benefits to the adoption of a collective impact model to address problems in Tasmania that lie at the nexus between LEPH. In reviewing existing collaborations, the authors demonstrate the value of a structural mapping process to identify ways forward for government and non-government agencies that are inclined to go further in merging the two disciplinary areas. The authors offer some suggestions with respect to identifying the preconditions for a collective impact model and how to build on these to initiate action. Originality/value A significant proportion of the literature on LEPH remains at a conceptual and theoretical level. This contribution highlights some practical issues while looking at existing examples of collaboration across LEPH at a state level in Australia, and starts mapping a way forward for constructing more integrative LEPH initiatives.

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