Supersensitivity psychosis and its response to asenapine in a patient with delusional disorder.

Ravi Philip Rajkumar

doi:10.1155/2014/215732

Abstract

Supersensitivity psychosis is a recognized complication of long-term antipsychotic treatment, in which patients develop new or reemergent psychotic symptoms, generally accompanied by dyskinetic movements, due to prolonged dopamine receptor blockade and resultant supersensitivity. Though it is most closely associated with schizophrenia and the use of typical antipsychotic agents, it has also been documented in patients with other diagnoses, and in those receiving atypical antipsychotics. There is no established treatment for this condition. In this paper, we describe a patient with persistent delusional disorder, jealous type, who developed a supersensitivity psychosis characterized by persecutory delusions, auditory hallucinations, and thought insertion in association with mild tardive dyskinesia. These symptoms resolved completely following six weeks of treatment with the second-generation antipsychotic asenapine, 20 mg/day. The mechanisms and implications of the patient's symptomatology and response are discussed.

Highlights

The term “supersensitivity psychosis” was first introduced into the psychiatric literature by Chouinard and Jones to refer to the emergence of psychotic symptoms in patients on long-term antipsychotic therapy [1, 2]
We report the case of a woman with delusional disorder who developed supersensitivity psychosis following ziprasidone therapy and who remitted when treated with the atypical antipsychotic asenapine
Our patient fulfilled all the revised diagnostic criteria for a supersensitivity psychosis proposed by Fallon et al [6, 15]

Summary

Introduction

The term “supersensitivity psychosis” was first introduced into the psychiatric literature by Chouinard and Jones to refer to the emergence of psychotic symptoms in patients on long-term antipsychotic therapy [1, 2]. Such symptoms are thought to result from dopamine receptor supersensitivity consequent to chronic blockade of D2 dopamine receptors in the mesolimbic pathway, a mechanism analogous to that of tardive dyskinesia [1], though other processes such as cholinergic neuronal loss have been proposed [3]. We report the case of a woman with delusional disorder who developed supersensitivity psychosis following ziprasidone therapy and who remitted when treated with the atypical antipsychotic asenapine

Case Report

Findings

Discussion