Cargando…

Treatment-resistant schizophrenia characterised by dopamine supersensitivity psychosis and efficacy of asenapine

Dopamine supersensitivity psychosis (DSP) frequently arises with long-term antipsychotic treatment and accounts for a significant proportion of treatment-resistant schizophrenia. The mechanism underlying DSP is thought to be a compensatory increase in dopamine receptor density in the striatum caused...

Descripción completa

Detalles Bibliográficos
Autores principales: Takao, Nagara, Murai, Toshiya, Fujiwara, Hironobu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8051386/
https://www.ncbi.nlm.nih.gov/pubmed/33849886
http://dx.doi.org/10.1136/bcr-2021-242495
_version_ 1783679737159221248
author Takao, Nagara
Murai, Toshiya
Fujiwara, Hironobu
author_facet Takao, Nagara
Murai, Toshiya
Fujiwara, Hironobu
author_sort Takao, Nagara
collection PubMed
description Dopamine supersensitivity psychosis (DSP) frequently arises with long-term antipsychotic treatment and accounts for a significant proportion of treatment-resistant schizophrenia. The mechanism underlying DSP is thought to be a compensatory increase in dopamine receptor density in the striatum caused by long-term antipsychotic treatment. Previous animal studies have reported that antipsychotics increase serotonin 5-HT2A receptor density in the striatum and that 5-HT2A receptor blockers suppress dopamine-sensitive psychomotor activity, which may be linked to the pathophysiology of DSP. In this paper, we describe a patient who was hospitalised with treatment-resistant schizophrenia. Following treatment with high-dose antipsychotic polypharmacy for 10 weeks, the patient experienced worsening of psychotic and extrapyramidal symptoms. The patient was then started on second-generation antipsychotic asenapine while other antipsychotics were tapered off, resulting in improvement of these symptoms. Retrospectively, we presumed that the high-dose antipsychotic polypharmacy caused DSP, which was effectively treated by the potent 5-HT2A receptor antagonism of asenapine.
format Online
Article
Text
id pubmed-8051386
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-80513862021-04-26 Treatment-resistant schizophrenia characterised by dopamine supersensitivity psychosis and efficacy of asenapine Takao, Nagara Murai, Toshiya Fujiwara, Hironobu BMJ Case Rep Case Report Dopamine supersensitivity psychosis (DSP) frequently arises with long-term antipsychotic treatment and accounts for a significant proportion of treatment-resistant schizophrenia. The mechanism underlying DSP is thought to be a compensatory increase in dopamine receptor density in the striatum caused by long-term antipsychotic treatment. Previous animal studies have reported that antipsychotics increase serotonin 5-HT2A receptor density in the striatum and that 5-HT2A receptor blockers suppress dopamine-sensitive psychomotor activity, which may be linked to the pathophysiology of DSP. In this paper, we describe a patient who was hospitalised with treatment-resistant schizophrenia. Following treatment with high-dose antipsychotic polypharmacy for 10 weeks, the patient experienced worsening of psychotic and extrapyramidal symptoms. The patient was then started on second-generation antipsychotic asenapine while other antipsychotics were tapered off, resulting in improvement of these symptoms. Retrospectively, we presumed that the high-dose antipsychotic polypharmacy caused DSP, which was effectively treated by the potent 5-HT2A receptor antagonism of asenapine. BMJ Publishing Group 2021-04-13 /pmc/articles/PMC8051386/ /pubmed/33849886 http://dx.doi.org/10.1136/bcr-2021-242495 Text en © BMJ Publishing Group Limited 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Case Report
Takao, Nagara
Murai, Toshiya
Fujiwara, Hironobu
Treatment-resistant schizophrenia characterised by dopamine supersensitivity psychosis and efficacy of asenapine
title Treatment-resistant schizophrenia characterised by dopamine supersensitivity psychosis and efficacy of asenapine
title_full Treatment-resistant schizophrenia characterised by dopamine supersensitivity psychosis and efficacy of asenapine
title_fullStr Treatment-resistant schizophrenia characterised by dopamine supersensitivity psychosis and efficacy of asenapine
title_full_unstemmed Treatment-resistant schizophrenia characterised by dopamine supersensitivity psychosis and efficacy of asenapine
title_short Treatment-resistant schizophrenia characterised by dopamine supersensitivity psychosis and efficacy of asenapine
title_sort treatment-resistant schizophrenia characterised by dopamine supersensitivity psychosis and efficacy of asenapine
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8051386/
https://www.ncbi.nlm.nih.gov/pubmed/33849886
http://dx.doi.org/10.1136/bcr-2021-242495
work_keys_str_mv AT takaonagara treatmentresistantschizophreniacharacterisedbydopaminesupersensitivitypsychosisandefficacyofasenapine
AT muraitoshiya treatmentresistantschizophreniacharacterisedbydopaminesupersensitivitypsychosisandefficacyofasenapine
AT fujiwarahironobu treatmentresistantschizophreniacharacterisedbydopaminesupersensitivitypsychosisandefficacyofasenapine