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Neuroleptic dysphoria: towards a new synthesis
1Institute of Medical Science, University of Toronto, Toronto, Canada.
Psychopharmacology
|December 3, 2003
Summary
Neuroleptic dysphoria (ND), an under-recognized antipsychotic side effect, involves unpleasant subjective changes. Newer antipsychotics may reduce these dysphoric responses, improving treatment adherence and quality of life.
Area of Science:
- Neuroscience
- Psychopharmacology
- Clinical Psychology
Background:
- Neuroleptic dysphoria (ND) is a subtle, under-recognized side effect of antipsychotic medications.
- It encompasses various unpleasant subjective changes in mood, motivation, and arousal induced by these drugs.
- Understanding ND has significant clinical and research implications for psychiatric treatment.
Purpose of the Study:
- To review historical neuroleptic drug studies in light of recent neuroimaging findings.
- To examine cumulative experience with second-generation antipsychotics (SGAs).
- To integrate new concepts like pleasure responsivity, hedonic regulation, and subjective tolerability.
Main Methods:
- Review of empirical studies on neuroleptic drugs.
- Inclusion of studies on schizophrenia, Tourette's disorder, and stuttering.
- Inclusion of studies on healthy volunteers and animal models.
Main Results:
- Dysphoric responses, including drug aversiveness, emerge early in treatment.
- Persistent dysphoria can lead to non-adherence, substance abuse, and reduced quality of life.
- Dopaminergic blockade in the prefrontal cortex and nucleus accumbens is the proposed mechanism; SGAs are less likely to cause ND.
Conclusions:
- Viewing ND within a spectrum of subjective tolerability disorders is crucial.
- Exploring neurobiological mechanisms of ND can inform antipsychotic therapy nuances.
- Understanding ND may help elucidate the pathophysiology of depression, substance abuse, and other dysphoric states.