Dopamine supersensitivity psychosis as a pivotal factor in treatment-resistant schizophrenia

Tomotaka Suzuki; Nobuhisa Kanahara; Hiroshi Yamanaka; Masayuki Takase; Hiroshi Kimura; Hiroyuki Watanabe; Masaomi Iyo

doi:10.1016/j.psychres.2015.02.021

Dopamine supersensitivity psychosis as a pivotal factor in treatment-resistant schizophrenia

Psychiatry Res. 2015 Jun 30;227(2-3):278-82. doi: 10.1016/j.psychres.2015.02.021. Epub 2015 Mar 31.

Authors

Tomotaka Suzuki¹, Nobuhisa Kanahara², Hiroshi Yamanaka³, Masayuki Takase⁴, Hiroshi Kimura⁴, Hiroyuki Watanabe⁵, Masaomi Iyo⁵

Affiliations

¹ Department of Psychiatry, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba 260-8670, Japan; Department of Psychiatry, Koutoku-kai Sato Hospital, 948-1 Kunugizuka, Nanyo City, Yamagata 999-2221, Japan.
² Department of Psychiatry, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba 260-8670, Japan; Division of Medical Treatment and Rehabilitation, Center for Forensic Mental Health, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba 260-8670, Japan. Electronic address: kanahara@faculty.chiba-u.jp.
³ Department of Psychiatry, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba 260-8670, Japan; Department of Psychiatry, Chiba Psychiatric Medical Center, 5 Toyosuna, Mihama-ku, Chiba 261-0024, Japan.
⁴ Department of Psychiatry, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba 260-8670, Japan.
⁵ Department of Psychiatry, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba 260-8670, Japan; Division of Medical Treatment and Rehabilitation, Center for Forensic Mental Health, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba 260-8670, Japan.

PMID: 25863824
DOI: 10.1016/j.psychres.2015.02.021

Abstract

There may be subtypes in treatment-resistant schizophrenia (TRS), and one of the subtypes may be related to dopamine supersensitivity psychosis (DSP). In developing strategies for prevention and treatment TRS, it is important to clarify the role of DSP in TRS. TRS patients were recruited from 3 hospitals for the present study. Through chart reviews, all patients were judged as either TRS or not, and then possible TRS patients were investigated about their past/present histories of DSP episode(s) by direct interviews. We then compared each factor between the groups with and without DSP episode(s). Out of 611 patients screened, 147 patients met the criteria for TRS and were included in the present analysis. These were divided into groups with and without DSP, comprising 106 (72.1%) and 41 patients (27.9%), respectively. Clinical characteristics in the two groups were similar, except for drug-induced movement disorders (DIMDs), which were significantly more important in DSP patients. Of the DSP patients, 42% and 56% experienced rebound psychosis and tolerance to antipsychotic effects, respectively. The present study revealed that approximately 70% of TRS patients experienced one or more DSP episodes, which may have a strong impact on the long-term prognosis of patients with schizophrenia.

Keywords: Antipsychotics; Clinical course; Deficit syndrome; Dopamine D2 receptor; Prognosis; Tardive dyskinesia; Treatment-resistant.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Antipsychotic Agents / adverse effects
Antipsychotic Agents / pharmacology
Antipsychotic Agents / therapeutic use*
Dopamine*
Drug Tolerance*
Female
Humans
Male
Middle Aged
Movement Disorders / diagnosis
Movement Disorders / drug therapy
Psychoses, Substance-Induced / diagnosis*
Psychoses, Substance-Induced / drug therapy*
Schizophrenia / diagnosis*
Schizophrenia / drug therapy*

Substances

Antipsychotic Agents
Dopamine