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Yin J, Barr AM, Ramos-Miguel A, Procyshyn RM. Antipsychotic Induced Dopamine Supersensitivity Psychosis: A Comprehensive Review. Curr Neuropharmacol 2017; 15:174-183. [PMID: 27264948 PMCID: PMC5327459 DOI: 10.2174/1570159x14666160606093602] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 05/16/2016] [Accepted: 05/31/2016] [Indexed: 02/06/2023] Open
Abstract
Chronic prescription of antipsychotics seems to lose its therapeutic benefits in the prevention of recurring psychotic symptoms. In many instances, the occurrence of relapse from initial remission is followed by an increase in dose of the prescribed antipsychotic. The current understanding of why this occurs is still in its infancy, but a controversial idea that has regained attention recently is the notion of iatrogenic dopamine supersensitivity. Studies on cell cultures and animal models have shown that long-term antipsychotic use is linked to both an upregulation of dopamine D<sub>2</sub>-receptors in the striatum and the emergence of enhanced receptor affinity to endogenous dopamine. These findings have been hypothesized to contribute to the phenomenon known as dopamine supersensitivity psychosis (DSP), which has been clinically typified as the foundation of rebound psychosis, drug tolerance, and tardive dyskinesia. The focus of this review is the update of evidence behind the classification of antipsychotic induced DSP and an investigation of its relationship to treatment resistance. Since antipsychotics are the foundation of illness management, a greater understanding of DSP and its prevention may greatly affect patient outcomes.
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Affiliation(s)
- John Yin
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, B.C., V6T 1Z3, Canada;
| | - Alasdair M. Barr
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, B.C., V6T 1Z3, Canada;
| | - Alfredo Ramos-Miguel
- Department of Psychiatry, University of British Columbia, Vancouver, B.C., V6T 2A1, Canada
| | - Ric M. Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, B.C., V6T 2A1, Canada
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Lin ST, Chen CC, Tsang HY, Lee CS, Yang P, Cheng KD, Li DJ, Wang CJ, Hsieh YC, Yang WC. Association Between Antipsychotic Use and Risk of Acute Myocardial Infarction. Circulation 2014; 130:235-43. [DOI: 10.1161/circulationaha.114.008779] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background—
Antipsychotic medications have been increasingly and more widely prescribed despite continued uncertainty about their association with the incidence of acute myocardial infarction (AMI).
Methods and Results—
We investigated the risk of AMI associated with antipsychotic treatment in 56 910 patients with schizophrenia, mood disorders, or dementia first hospitalized or visiting an emergency room for AMI in 1999 to 2009. A case-crossover design was used to compare the distributions of antipsychotic exposure for the same patient across 1 to 30 and 91 to 120 days just before the AMI event. Adjustments were made for comedications and outpatient visits. The adjusted odds ratio of AMI risk was 2.52 (95% confidence interval, 2.37–2.68) for any antipsychotics, 2.32 (95% confidence interval, 2.17–2.47) for first-generation antipsychotics, and 2.74 (95% confidence interval, 2.49–3.02) for second-generation antipsychotics. The risk significantly increased (
P
<0.001) with elevations in dosage and in short-term use (≤30 days). Male patients, elderly patients, and patients with dementia were at significantly increased risk (all
P
<0.001). Physically healthier patients with no preexisting diabetes mellitus, hypertension, or dyslipidemia were at significantly greater risk (
P
<0.001), largely because they had been exposed to higher doses of antipsychotics (
P
<0.001). A study of the selected binding of antipsychotics to 14 neurotransmitter receptors revealed only dopamine type 3 receptor antagonism to be significantly associated with AMI risk (adjusted odds ratio, 2.59; 95% confidence interval, 2.43–2.75;
P
<0.0001).
Conclusions—
Antipsychotic use may be associated with a transient increase in risk for AMI, possibly mediated by dopamine type 3 receptor blockades. Further education on drug safety and research into the underlying biological mechanisms are needed.
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Affiliation(s)
- Shuai-Ting Lin
- From the Department of Psychiatry, Kaohsiung Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (S.-T.L., C.-C.C., H.-Y.T., K.-D.C., D.-J.L., C.-J.W., Y.-C.H., W.-C.Y.); Graduate Institute of Medicine, College of Medicine (S.-T.L., P.Y.) and Department of Psychiatry, Faculty of Medicine (P.Y.), College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; and Division of Cardiology, Department of Internal Medicine (C.-S.L.) and Department of Psychiatry (P.Y.), Kaohsiung Medical University and
| | - Cheng-Chung Chen
- From the Department of Psychiatry, Kaohsiung Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (S.-T.L., C.-C.C., H.-Y.T., K.-D.C., D.-J.L., C.-J.W., Y.-C.H., W.-C.Y.); Graduate Institute of Medicine, College of Medicine (S.-T.L., P.Y.) and Department of Psychiatry, Faculty of Medicine (P.Y.), College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; and Division of Cardiology, Department of Internal Medicine (C.-S.L.) and Department of Psychiatry (P.Y.), Kaohsiung Medical University and
| | - Hin-Yeung Tsang
- From the Department of Psychiatry, Kaohsiung Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (S.-T.L., C.-C.C., H.-Y.T., K.-D.C., D.-J.L., C.-J.W., Y.-C.H., W.-C.Y.); Graduate Institute of Medicine, College of Medicine (S.-T.L., P.Y.) and Department of Psychiatry, Faculty of Medicine (P.Y.), College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; and Division of Cardiology, Department of Internal Medicine (C.-S.L.) and Department of Psychiatry (P.Y.), Kaohsiung Medical University and
| | - Chee-Siong Lee
- From the Department of Psychiatry, Kaohsiung Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (S.-T.L., C.-C.C., H.-Y.T., K.-D.C., D.-J.L., C.-J.W., Y.-C.H., W.-C.Y.); Graduate Institute of Medicine, College of Medicine (S.-T.L., P.Y.) and Department of Psychiatry, Faculty of Medicine (P.Y.), College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; and Division of Cardiology, Department of Internal Medicine (C.-S.L.) and Department of Psychiatry (P.Y.), Kaohsiung Medical University and
| | - Pinchen Yang
- From the Department of Psychiatry, Kaohsiung Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (S.-T.L., C.-C.C., H.-Y.T., K.-D.C., D.-J.L., C.-J.W., Y.-C.H., W.-C.Y.); Graduate Institute of Medicine, College of Medicine (S.-T.L., P.Y.) and Department of Psychiatry, Faculty of Medicine (P.Y.), College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; and Division of Cardiology, Department of Internal Medicine (C.-S.L.) and Department of Psychiatry (P.Y.), Kaohsiung Medical University and
| | - Kai-Da Cheng
- From the Department of Psychiatry, Kaohsiung Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (S.-T.L., C.-C.C., H.-Y.T., K.-D.C., D.-J.L., C.-J.W., Y.-C.H., W.-C.Y.); Graduate Institute of Medicine, College of Medicine (S.-T.L., P.Y.) and Department of Psychiatry, Faculty of Medicine (P.Y.), College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; and Division of Cardiology, Department of Internal Medicine (C.-S.L.) and Department of Psychiatry (P.Y.), Kaohsiung Medical University and
| | - Dian-Jeng Li
- From the Department of Psychiatry, Kaohsiung Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (S.-T.L., C.-C.C., H.-Y.T., K.-D.C., D.-J.L., C.-J.W., Y.-C.H., W.-C.Y.); Graduate Institute of Medicine, College of Medicine (S.-T.L., P.Y.) and Department of Psychiatry, Faculty of Medicine (P.Y.), College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; and Division of Cardiology, Department of Internal Medicine (C.-S.L.) and Department of Psychiatry (P.Y.), Kaohsiung Medical University and
| | - Chin-Jen Wang
- From the Department of Psychiatry, Kaohsiung Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (S.-T.L., C.-C.C., H.-Y.T., K.-D.C., D.-J.L., C.-J.W., Y.-C.H., W.-C.Y.); Graduate Institute of Medicine, College of Medicine (S.-T.L., P.Y.) and Department of Psychiatry, Faculty of Medicine (P.Y.), College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; and Division of Cardiology, Department of Internal Medicine (C.-S.L.) and Department of Psychiatry (P.Y.), Kaohsiung Medical University and
| | - Yung-Chi Hsieh
- From the Department of Psychiatry, Kaohsiung Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (S.-T.L., C.-C.C., H.-Y.T., K.-D.C., D.-J.L., C.-J.W., Y.-C.H., W.-C.Y.); Graduate Institute of Medicine, College of Medicine (S.-T.L., P.Y.) and Department of Psychiatry, Faculty of Medicine (P.Y.), College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; and Division of Cardiology, Department of Internal Medicine (C.-S.L.) and Department of Psychiatry (P.Y.), Kaohsiung Medical University and
| | - Wei-Cheng Yang
- From the Department of Psychiatry, Kaohsiung Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan (S.-T.L., C.-C.C., H.-Y.T., K.-D.C., D.-J.L., C.-J.W., Y.-C.H., W.-C.Y.); Graduate Institute of Medicine, College of Medicine (S.-T.L., P.Y.) and Department of Psychiatry, Faculty of Medicine (P.Y.), College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; and Division of Cardiology, Department of Internal Medicine (C.-S.L.) and Department of Psychiatry (P.Y.), Kaohsiung Medical University and
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