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Psychoses of Dopamine Hypersensitivity During the Antipsychotic Pharmacotherapy of Schizophrenia: What Clinician Needs to Know

S.N. Mosolov
Moscow Research Institute of Psychiatry, Moscow, Russia

Abstract
The article presents a review literature on psychosis of dopamine hypersensitivity (PDH), which is observed in patients with schizophrenia during the long-term antipsychotic pharmacotherapy, and is characterized by acute exacerbation of psychotic symptoms in stable patients after dose decrease, withdrawal of antipsychotic or switching to other antipsychotic, and often is going along with tardive dyskinesia. PDH first was described in late 1970’s on classical neuroleptics, but recently several case reports of PDH have been described on atypical antipsychotics. PDH aggravates the course of schizophrenia and increases risk of therapy resistance. From basic research PDH could be explained by a compensatory phenomenon of D2 receptors up-regulation (increasing density and sensitivity) due to long-term blocking by antipsychotics with potent D2 antagonistic activity. The paper reviews recent data about clinical characteristics and pathogenetic mechanisms of PDH and discusses some practical recommendations on treatment and prevention.

Keywords: 
psychosis of dopamine supersensitivity
schizophrenia
antipsychotics
tardive dyskinesia
therapy resistance

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