Title:Recent Discussions on Dopamine Supersensitivity Psychosis: Eight Points to Consider When Diagnosing Treatment-Resistant Schizophrenia
Volume: 19
Issue: 12
Author(s): Nobuhisa Kanahara*, Hiroshi Kimura, Yasunori Oda, Fumiaki Ito and Masaomi Iyo
Affiliation:
- Division of Medical Treatment and Rehabilitation, Center for Forensic Mental Health, Chiba University, Chiba,Japan
Keywords:
Antipsychotic, dopamine, dopamine partial agonist, tardive dyskinesia, receptor, relapse, withdrawal.
Abstract: Dopamine supersensitivity psychosis is a clinical concept characterized by an unstable
psychotic state and tardive dyskinesia in schizophrenia patients at the chronic stage. This state is
thought to be induced by compensatory upregulation of dopamine D2 receptors, which is provoked
by long-term and/or high-dose medications. Recent clinical data suggest that patients who responded
well to medication but later exhibit dopamine supersensitivity develop tolerance to antipsychotics’
effects and eventually transit to treatment-resistant schizophrenia, indicating that dopamine
supersensitivity could be an etiology contributing to treatment-resistant schizophrenia.
However, clinicians and researchers consider dopamine supersensitivity psychosis a minor phenomenon
during the clinical course and do not make much of it. This opinion is often based on numerous
clinical data indicating that dopamine supersensitivity psychosis is a relatively rare event. This
review examines the data dealing with dopamine supersensitivity with the five themes of frequency,
severity, withdrawal studies, switching to aripiprazole, and tardive dyskinesia. These effects of
these themes on discussions of the clinical meaning of dopamine supersensitivity psychosis are
then reviewed. The present review will help clinicians speculate about the background of severe
psychopathology in a given patient; to make diagnoses of treatment-resistant schizophrenia and dopamine
supersensitivity psychosis; and plan antipsychotic medication regimens with the goal of
achieving better long-term prognosis.
