Phenomenology and pathophysiology of antipsychotic withdrawal symptoms (original) (raw)
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Antipsychotic withdrawal symptoms: Phenomenology and pathophysiology
Acta Psychiatrica Scandinavica, 1988
The authors review the literature discribing non-dyskinetic antipsychotic withdrawal phenomena. Withdrawal of these agents can cause nausea, emesis, anorexia, diarrhea, rhinorrhea, diaphoresis, myalgia, paresthesia, anxiety, agitation, restlessness, and insomnia. Psychotic relapse is often presaged by increased anxiety, agitation, restlessness and insomnia, but the temporal relationship of these prodromal symptoms to reduction in the dosage or discontinuation of neuroleptics distinguishes them from the effects of abrupt withdrawal.
Acta Psychiatrica Scandinavica, 2006
Moncrieff J. Does antipsychotic withdrawal provoke psychosis? Review of the literature on rapid onset psychosis (supersensitivity psychosis) and withdrawal-related relapse. Objective: To examine the evidence that discontinuation of long-term antipsychotic medication, including clozapine, may provoke a psychotic episode. Method: Databases were searched and citations scrutinised. Results: Evidence for a rapid onset psychosis (supersensitivity psychosis) following clozapine withdrawal was found and weaker evidence that this might occur with some other antipsychotic drugs. Some cases were reported in people without a psychiatric history. It appears that the psychosis may be a feature of drug withdrawal rather than the re-emergence of an underlying illness, at least in some patients. Meta-analyses of withdrawal studies have suggested that antipsychotic discontinuation may also increase the risk of relapse over and above the risk because of the underlying disorder, but not all individual studies show this effect. Mechanisms may relate to brain adaptations to long-term drug use but data are sparse. Conclusion: These effects require further urgent research. Interventions to reduce morbidity after drug withdrawal need to be developed.
Clinical predictors of relapse following neuroleptic withdrawal
Biological Psychiatry, 1992
The validity of previously hypothesized predictors of elapse following neuroleptic discontinuation was examined. One hundred sixty-two outpatients, with either Research Diagnotic Criteria schizophrenia or schizoaffective disorder, were discontinued from neuroleptic medication for a 28-day period or until judged to be relapsed. Pre-discontinuation neuroleptic dosage level, the severity of psychotic symptoms, and the presence of dyskinetic movements prior to neuroleptic discontinuation were the predictor variables. Of the 162 patients, 62.7% did not relapse during the study period. There were no differences in the survival rates between the patients withdrawn from oral versus depot neuroleptics. Neuroleptic dosage, but not severiO, of psychotic symptoms or dyskinetic movements, predicted relapse. These results support the hypothesis that pre-withdrawal neuroleptic dosage level predicts relapse, but fail to validate either severity of psychotic symptoms or presence of dyskbletic movements as predictors of relapse.
Attempting to discontinue antipsychotic medication: Withdrawal methods, relapse and success
Psychiatry Research, 2018
Welcome to The Experiences of Antipsychotic Medication Survey. This survey is in 4 parts and usually takes 30-45 minutes to complete. Not all questions will be relevant to you, so the time taken to complete the survey will be different for each person. Some questions may seem repetitive. Please answer these questions anyway. If you do not remember something, you can select or write 'I don't remember' and carry on to the next question.
Psychotropic discontinuation symptoms: a case of withdrawal neuroleptic malignant syndrome
General Hospital Psychiatry, 2006
Introduction: Although recent publications have focused on discontinuation symptoms of antidepressant medications, most classes of psychotropic drugs have been reported to have withdrawal symptoms. In light of the increased rate of psychotropic prescribing by primary care physicians, it is important for all physicians to be aware of psychotropic withdrawal symptoms. Case Report: We report on a patient who developed symptoms consistent with neuroleptic malignant syndrome after abrupt discontinuation of a variety of psychotropic medications. Methods: A MEDLINE search including both articles and letters to the editor was performed to identify symptoms reported in association with the discontinuation of psychotropic medications.
Acta Psychiatrica Scandinavica, 1985
ABSTRACT– Neuroleptics were withdrawn abruptly from 14 hospitalized chronic schizophrenics. For 12 weeks the patients were observed from the aspect of psychic change and the development of withdrawal dyskinesia. Serum prolactin level, plasma dopamine-beta-hydroxylase activity, cerebrospinal fluid homovanillic acid and norepinephrine levels were measured on the day prior to withdrawal and on day 14 of the study. Psychic deterioration showed no association with any of the tested biochemical parameters. The decrease in the CSF HVA and NE levels of the patients displaying symptoms of withdrawal dyskinesia was significantly smaller than in those displaying no dyskinesia.
Withdrawal-emergent dyskinesia in patients with schizophrenia during antipsychotic discontinuation
Biological Psychiatry, 1995
We examined whether patients exhibiting withdrawal-emergent dyskinesia (WE-D) represent a group vulnerable to subsequent development oftardive dyskinesia (TD). WE-D was defined as moderate abnormal movements during antipsychotic withdrawal in persons without persistent TD. We assessed patients with schizophrenia-spectrum illness participating in withdrawal from antipsychotic medication. Patients with WE-D were compared to those without dyskinesia and to those with persistent TD. Clinical measures included duration of illness and antipsychotic exposure, negative symptoms, and neurologic soft signs. We hypothesized that WE-D patients would not differ from persistent-TD patients across the above variables, but would differ from non-TD patients. Patients without TD significantly differed from persistent TD in duration of illness, medication exposure and neurologic soft signs. WE-D did not differ from TD across these measures. No-TD patients also showed less duration of medication exposure and neurotogic soft signs than those with WE-D.