Is neuroleptic dysphoria a healthy response?

We examined the relationship between neuroleptic-induced extrapyramidal effects, subjective neuroleptic dysphoria, and clinical outcome in acutely psychotic inpatients. Thirteen of 50 consecutively admitted patients experienced severe neuroleptic dysphoria. Dysphoric patients were less likely to comply with neuroleptic, but nine did complete neuroleptic trials. The compliant dysphoric inpatients received significantly lower neuroleptic doses compared with nondysphoric patients, and yet had equivalent overall improvement of psychotic symptoms and less severe extrapyramidal effects. Despite having fewer physical signs of akinesia, dysphoric patients were significantly more distressed from akinesia than nondysphoric. We conclude that while some neuroleptic dysphoric patients become noncompliant, others benefit from dysphoria by negotiating for lower, less toxic, and yet effective neuroleptic dosages.