Psychoses Tardive psychosis

One of the panelists, Barry D. Jones, warned, Some patients who seem to require lifelong neuroleptics may actually do so because of this therapy. In the published version (Chouinard et al., 1980), the authors suggested that the irreversible supersensitivity psychosis results from rebound hyperactivity of the blockaded dopamine receptors in the limbic system. They compared the mechanism of supersensitivity psychosis to that of TD. Tardive psychosis may be a mental manifestation of the same processes that cause the motor phenomena of TD. 

Although Chouinard and Jones (1980) found a prevalence of 30% to 40%, Hunt et al. (1988) reviewed the charts of 265 patients and located onlyl2 probable and no definite cases of tardive psychosis. Kirkpatrick et al. (1992) cast a critical eye on the existence of tardive psychosis. Research commonly fails to detect even the most obvious adverse drug effects, resulting in so many drugs reaching the market without their most serious side effects being detected. That so many researchers have documented tardive psychosis should, by now, confirm its existence. 

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). 

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. 

After an apparent recovery, many of the encephalitis victims later went on to develop severe psychoses and dementia (Abrahamson, 1935 Matheson Commission, 1939). Thus the completion of the parallel between lethargic encephalitis and neuroleptic effects awaited the discovery that in addition to TD, tardive psychosis and tardive dementia could follow the exposure to neuroleptics. 

Caution History of peptic ulcer disease, dementia, psychosis, tardive dyskinesia, profound tremor, cardiac dysrhythmias... 

Friedman J. Clozapine treatment of psychosis in patients with tardive dystonia. Movement Disord 1994 9 321-324. 

In view of the risk/benefit ratio for clozapine, this agent is not generally considered a first-line agent for the treatment of psychosis but one to consider when several other agents have failed. It is especially useful in quelling violence and aggression in difficult patients, may reduce suicide rates in schizophrenia, and may reduce tardive dyskinesia severity, especially over long treatment intervals. 

Oosthuizen PP, Emsley RA, MaritzJS, et al. Incidence of tardive dyskinesia in first-episode psychosis patients treated with low-dose haloperidol. J Clin Psychiatry. 2003 64 1075-1080. 

It takes no great imagination to grasp the suffering of a patient condemned to even a relatively mild tardive akathisia for a lifetime. I have seen cases of this kind that were previously mistaken for severe anxiety or agitated depression. Chapter 3 reviewed research indicating that acute akathisia can drive a patient into psychosis and to violence and/or suicide. Considering the millions of patients subjected to this torment, the problem takes on epidemic proportions. 

Chapter 3 documented that the neuroleptics can produce acute depression and psychosis. This chapter has documented the existence of tardive dysmentia and tardive dementia as well as tardive behavioral abnormalities in children. There is further evidence that the neuroleptics can... 

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