Effects of brief neuroleptic discontinuation in chronic hospitalized schizophernic patients: no evidence for supersensitivity psychosis

Abstract

As many as one third of patients suffering from schizophrenia have persistent severe psychotic symptoms despite high doses of neuroleptic treattaunt. Increased psychotic symptoms because of receptor sensitization psychosis has been proposed as possible side effects of chronic neuroleptic exposure. As part of a protocol to medicate chronic hospitalized treatment resistant schizophrenic patients (DSM-Ill-R and SADS/RDC) with clozapine, we evaluated the effects of discontinuing treatment with high doses of neuroleptics for evidence of a psychosis. Twenty chronic schizophrenic patients, hospitalized for at least 24 months, were tapered of all their neureleptic medication over an average of 42 days. All patients were on large doses of antipsychotic medication (mean + sd = 2058 4-1243 chlorpromazine equivalents). No significant differences were found in pairwise t-tests to evaluate BPRS scores between baseline, end of taper, one and three weeks medication free periods. Multivariate analysis for testing differences between BPRS subscales (positive, negative, agitation, affective) also showed no significant difference. in treatment-resistant chronic schizophrenic patients there is no evidence that high doses of neuroleptics are beneficial, as evidenced by the absence of any deterioration during a period of neuroleptic taper and withdrawal. There is also no support for the idea of a supersensitivity psychosis as evidenced by the absence of any increase in psychotic symptomatulogy.