Supersensitivity psychosis

Moncrieff J. Does antipsychotic withdrawal provoke psychosis Review of the literature on rapid onset psychosis (supersensitivity psychosis) and withdrawal-related relapse. Acta Psychiatr Scand 2006 114(1) 3-13. 

Chouinard G, Vainer JL, Belanger M-G, et al. Risperidone and clozapine in the treatment of drug-resistant schizophrenia and neuroleptic-induced supersensitivity psychosis. Prog Neuro-Psychopharmacol Biol Psychiatry 1994 18 1129-1141. 

Hunt Jl, Singh H, Simpson GM. Neuroleptic-induced supersensitivity psychosis retrospective study of schizophrenic inpatients. J Clin Psychiatry 1988 49 258-261. 

Peet M. Supersensitivity psychosis [Letter]. J Clin Psychiatry 1991 52 90. 

Singh H, Hunt JL, Vitiello B, et al. Neuroleptic withdrawal in patients meeting criteria for supersensitivity psychosis. J Clin Psychiatry 1990 51 319-321. 

Chouinard, G. Jones, B. D. 1980, Neuroleptic-induced supersensitivity psychosis clinical and pharmacologic characteristics, Am.J.Psychiatry, vol. 137, no. 1, pp. 16-21. 

When Chouinard and Jones first announced their discovery of tardive or supersensitivity psychosis at the annual meeting of the Canadian Psychiatric Association (see Jancin, 1979), one psychiatrist in the audience protested,... 

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. 

Chouinard and Jones (1980) noted that both the TD and the supersensitivity psychosis are masked, or hidden, when the patient is taking drugs. They further stated that continuous use of the drugs tends to worsen both diseases. Neuroleptic-treated patients have often developed tardive psychoses that became more severe than their original psychiatric disorders (Chouinard et al., 1980 Chouinard et al., 1982 Chouinard et al., 1978 Csernansky et al., 1982 Hunt et al., 1988 Mayerhoff et al., 1992 see also news reports by Jancin, 1979 Supersensitivity Psychosis, 1983). Tragically, patients can require lifetime medication for a disorder that could have had a much shorter and more benign natural history. 

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). 

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. 

Chouinard, G., Jones, B. (1982). Neuroleptic-induced supersensitivity psychosis, the hump course, and tardive dyskinesia. Journal of Clinical Psychopharmacology, 2, 143-144. 

Csernansky, J., Hollister, L. E. (1982). Probable case of supersensitivity psychosis. Hospital Formulary, 17, 395-399. 

Hunt, J., Singh, H., Simpson, G. (1988). Neuroleptic-induced supersensitivity psychosis Retrospective study of schizophrenic inpatients. Journal of Clinical Psychiatry, 49, 258-261. 

Kirkpatrick, B., Alphs, L., Buchanan, R. (1992). The concept of supersensitivity psychosis. Journal of Nervous and Mental Diseases, 180, 265-270. 

Llorca, P., Vaiva, G., Lancon, C. (2001). Supersensitivity psychosis in patients with schizophrenia after sudden olanzapine withdrawal. Canadian Journal of Psychiatry, 46, 87-88. 

Miller, R., Chouinard, G. (1993). Loss of striatal cholinergic neurons as a basis for tardive and L-dopa-induced dyskinesias, neuroleptic-induced supersensitivity psychosis and refractory schizophrenia. Biological Psychiatry, 34, 713-738. 

Supersensitivity psychosis thought to often follow withdrawal of neuroleptics after extended use. (1983, September 1). Psychiatric News, p. 39. 

Chouinard G, Jones BD. Neuroleptic-induced supersensitivity psychosis clinical and pharmacologic characteristics. 

Ekblom B, Eriksson K, Lindstrom LH. Supersensitivity psychosis in schizophrenic patients after sudden clozapine 230. withdrawal. Psychopharmacology (Berl) 1984 83(3) 293 l. 

Supersensitivity psychosis has been reported in two men, aged 74 and 65 years, who had taken metoclopramide 5 mg qds for 6 and 3 months respectively (536). Hallucinations and delusions developed 12 hours after the drug was withdrawn in one patient and 3 days after withdrawal in the other. Both recovered after treatment with risperidone. 

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