Tardive Psychosis in Neuroleptic-Treated Patients

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 

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, 

I put my patients on neuroleptic drugs because they re psychotic. Now you re saying that the same drug that controls their schizophrenia also causes a psychosis and that on top of that the drug causes tardive dyskinesia one third of the time. It s a Hobson s choice. My patients are going to lose in the end either way. 

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. 

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