Psychiatry Avoids Facing Tardive Psychosis

Since my lengthy review of the subject in Psychiatric Drugs Hazards to the Brain (1983b), and then in the 1997 edition of this book, the literature 

The 2003 edition of The American Psychiatric Publishing Textbook of Clinical Psychiatry makes no mention of tardive psychosis or supersensitivity psychosis in the discussion of adverse neuroleptic effects, including in the section Tardive Disorders (Hales et al., 2003). Nor is there any discussion of the many studies on cognitive deficits associated with neuroleptics and in particular with TD. The only mention of tardive psychosis occurs within a discussion of mood disorders with citations to three studies spanning 1991-1993. The 1993 study points to a possible biological mechanism in the death of striatal cholinergic neurons, caused by prolonged exposure to neuroleptics (Miller et al., 1993). 

It is as if the profession has found the concept intolerable—that taking so-called antipsychotic drugs for prolonged periods of time causes a persistent psychosis worse than the original disorder—so it has chosen to ignore it. It is similar to the resistance we will find to admitting that so-called antidepressants, even in the short run, cause depression and suicidality (chapters 6 and 7). 

Nonetheless, some studies continue to crop up, and concerns continue to be expressed. Llorca et al. (2001) described a case of supersensitivity psychosis following abrupt olanzapine withdrawal. Lu et al. (2002) reported two cases of older patients who developed hallucinations and delusions following withdrawal from metoclopramide (Reglan). 

Stanilla et al. (1997) described three cases of delirium with psychotic symptoms due to clozapine withdrawal (see also Adams et al., 1991, for an early report of clozapine withdrawal psychosis). They believed that clozapine produces more severe withdrawal symptoms than typical antipsychotic agents. In a 3-year open label study of quetiapine, Margolese et al. (2004) switched 23 male patients from classical antipsychotics and risperidone to quetiapine Six of the seven patients who relapsed after being stabilized on quetiapine for at least three months met the criteria for supersensitivity psychosis. This is a very high rate, again raising questions about whether atypicals may be more prone to cause tardive psychosis. 

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