Adverse response to neuroleptics in schizophrenia

Negative therapeutic reactions to neuroleptics in schizophrenic patients are examined from the psychoanalytic perspective through case examples. Intrapsychic changes resulting from this medication, ordinarily considered beneficial, are shown, in some cases, to be disruptive of schizophrenic functioning and organization and potentially to endanger the continuation of medication itself. Changes are described which effect defenses, object relations, psychotic restitution, use of external reality, body image and cognition, and the symbolic significance of medication. Alterations in narcissistic ego states and disruption in preconscious processes, superimposed upon defective ego functioning, are used as explanatory concepts. These interact with transference based responses; in some cases, important psychodynamic issues emerge amenable to transference interpretations. Further study of intrapsychic changes may be useful in delineating a previously inexplicable response, understanding symptom formation, recognizing shifts in the patient-psychotherapist relationship, and forestalling premature cessation of medication.