Dopamine supersensitivity psychosis
Hypothesis linking antipsychotic use to worsening psychosis via dopamine sensitivity.
Last updated
Dopamine supersensitivity psychosis is a hypothesis that attempts to explain why some individuals experience worsening psychotic symptoms—such as hallucinations and delusions—despite treatment with escalating doses of antipsychotics. The theory proposes that long-term use of antipsychotics, which block dopamine D2 receptors, may lead to compensatory changes in the brain, including upregulation of these receptors, making neurons more sensitive to dopamine. This increased sensitivity may paradoxically reduce the effectiveness of antipsychotics and contribute to relapse or worsening psychosis.
Quick Facts
- Field
- Psychiatry, Neuroscience
- First described
- 1978
- Alternative name
- Tardive psychosis
Facts from the source article.
Background
The concept of dopamine supersensitivity psychosis emerged in 1978, with a featured concern being increasing resistance to medication, requiring higher doses or not responding to higher doses. Some articles use the term 'tardive psychosis' to reference this specific concept, though its validity has been disputed. The condition is not rare and has been identified in a substantial proportion of patients; Palmstierna asserts that tardive psychosis is a combination of several different and not necessarily correlated phenomena related to neuroleptic treatment of schizophrenia.
The mechanism is thought to involve upregulation of dopamine D2 receptors in response to chronic antipsychotic blockade. While studies show about a 3-fold increase in sensitivity to dopamine in people taking antipsychotics chronically, the actual increase in D2 receptor numbers is only about 1.4-fold in the striatum of people with schizophrenia, suggesting other factors such as changes in the proportion of active (D2High) versus inactive (D2Low) receptor conformations may also play a role. Tardive dyskinesia, a common movement disorder caused by antipsychotics, may also result from dopamine receptor sensitization, which could explain why increasing the antipsychotic dose temporarily improves symptoms and why abrupt discontinuation can cause withdrawal-emergent dyskinesia.
More in Psychopathological syndromes
Sources
Compiled from Wikipedia and the sources listed below. Text from Wikipedia is available under CC BY-SA 4.0; this entry is adapted from it.
- Wikipedia: Dopamine supersensitivity psychosis (CC BY-SA 4.0).
- Word definitions: the , each quoted from its Wikipedia article.
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