Case Presentation: Iatrogenic Psychosis

Abstract

Tardive dyskinesia (TD) is a neuromuscular disorder that can precipitate following the administration of dopamine receptor antagonists such as neuroleptics. Withdrawal-emergent dyskinesia (WE-D), a less recognized subtype of TD, can manifest shortly after abrupt cessation of antipsychotic use regardless of the neuroleptic subclass used. Super sensitivity psychosis is another possible symptom of acute withdrawal from neuroleptics that can occur alone or concomitant with WE-D. Because of their ever increasing off-label indications and attenuated extrapyramidal side effect profiles, atypical antipsychotics are becoming ubiquitous in both inpatient and outpatient settings, reflecting their utility. However, it is likely that this trend will also result in a greater prevalence of WE-D and super sensitivity psychosis. Clinicians without expertise in the utilization of neuroleptics are likely to misattribute withdrawal symptoms precipitated by abrupt cessation of antipsychotics with toxicity to these agents and erroneously withhold or delay their reinitiation, thereby exacerbating symptoms and inadvertently prolonging patient distress. This case report will illustrate the unique and perplexing presentation of WE-D and super sensitivity psychosis in an acute setting, and provide an effective diagnostic and treatment approach to resolving these conditions.