Antipsychotic Drug-Induced Dysphoria

King, David J.; Burke, Michael A.; Lucas, Richard

doi:10.1192/bjp.167.4.480

Cited by 59 publications

(48 citation statements)

References 14 publications

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“…From our data, in line with proposals from King et al (1995), it would appear that there was some dissociation between these two conditions, in that all subjects recognised an inner restlessness, whereas only half the sample reported dysphoria. In addition, among subjects reporting dysphoria there appeared to be a number of dierent processes leading to what may be substantially dierent experiences coded under a common rubric.…”

Section: Discussion These Results Have Implications For a Number Of Dsupporting

confidence: 89%

“…dose to volunteers produced no restlessness or other eects during the subsequent hour and a half as measured using visual analogue rating scales. The dierences between their ®ndings and both ours and those of King et al (1995) may stem from a number of sources. One possibility is that intravenous preparations of haloperidol or other compounds might produce a quite dierent side eect pro®le to oral preparations; there is some evidence in support of this.…”

Section: Discussion These Results Have Implications For a Number Of Dmentioning

confidence: 91%

“…King and colleagues (King et al, 1995;Lynch et al, 1996) reported akathisia and dysphoria in healthy volunteers following haloperidol 5 mg. Half of their subjects were aected by what was, in terms of dose equivalents, possibly a somewhat larger dose of neuroleptic than ours. The time course of side eects was comparable to that found in this study Ð appearing after 3 h and lasting for 8 h or more.…”

Section: Discussion These Results Have Implications For a Number Of Dmentioning

confidence: 98%

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Immediate effects of droperidol

Healy

Farquhar

1998

Hum. Psychopharmacol. Clin. Exp.

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The subjective and behavioural responses of 20 healthy volunteers taking droperidol 5 mg as part of a cognitive challenge programme were catalogued. Some form of akathisia was universally experienced. Half of the subjects were dysphoric, but there appeared to be a number of dierent inputs to their dysphoria and a range of other eects were noted, including sedation, dissociative experiences, alterations in sensation and subtle changes in physiognomy. The duration of these eects varied from a few hours to over a week. In the acute phase, insight as to the origin of what was happening was mixed. The results have implications for the interpretation of cognitive challenge tests, the nature of akathisia, clinical therapeutics and drug development. #

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Section: Discussion These Results Have Implications For a Number Of Dsupporting

confidence: 89%

Section: Discussion These Results Have Implications For a Number Of Dmentioning

confidence: 91%

Section: Discussion These Results Have Implications For a Number Of Dmentioning

confidence: 98%

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Immediate effects of droperidol

Healy

Farquhar

1998

Hum. Psychopharmacol. Clin. Exp.

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“…EPS are extremely worrying and stigmatizing for patients. Moreover, they are accompanied by emotional [43] and cognitive disturbances [44] and are liable to give rise to tardive dyskinesia [45] . With this in mind, we had better evaluate the actual risks of EPS in an index like the number needed to harm, rather than cling to the apparently simple distinction between 'typicals' and 'atypicals'.…”

Section: Resultsmentioning

confidence: 99%

Typical and Atypical Antipsychotics – The Misleading Dichotomy

et al. 2008

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Objectives: (1) To investigate the risk of extrapyramidal motor side effects (EPS) associated with the prescription of different antipsychotics under naturalistic treatment conditions; (2) to test the rationale of the terms ‘typical’ and ‘atypical’ based on EPS rates. Design: Cross-sectional study in the federal state of Bavaria. Setting: 20 psychiatric hospitals in Bavaria. Participants: 6,061 inpatients, aged 18–65 years, with psychotic disorders. Main Outcome Measures: Co-medication with the anticholinergic biperiden was used as an index of EPS. Odds ratios for EPS and numbers needed to harm [number of patients who would need to be treated to obtain one more case with an adverse outcome (i.e. EPS) as compared with the control treatment (clozapine)] were calculated to obtain risk estimates for 15 different antipsychotics. Results: Groups of ‘typical’ and ‘atypical’ antipsychotics were not homogeneous in their EPS rates, and showed wide variation within each group. Nor did the frequency of EPS allow a clear distinction between the groups. There were 2 reasons for this: first, EPS rates rose continuously over the whole spectrum of drugs under study, and therefore precluded the definition of a cut-off score; second, there was considerable overlap between the 2 groups as EPS rates of various ‘atypicals’ (e.g. amisulpride, risperidone and zotepine) did not differ from some ‘typical’ substances (e.g. fluphenazine), while one ‘typical’ antipsychotic (perazine) even had a lower EPS risk than most ‘atypicals’. Conclusions: The odds of inducing EPS are not distinguishable between ‘typical’ and ‘atypical’ antipsychotics as EPS rates rise on a continuous scale throughout both classes. We propose dropping the categorization of antipsychotics as ‘typical’ and ‘atypical’ and instead using risk estimates like number needed to harm for EPS to help in benefit/risk considerations for antipsychotic treatment.

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“…One study in normal volunteers (King et al, 1995) demonstrated that dysphoria often occurs in the absence of motor restlessness and can thus be underdiagnosed. It is possible that some patients with schizophrenia presenting with depressive symptoms may in fact be troubled by antipsychoticinduced dysphoria, without the associated motor aspects of akathisia that make the diagnosis more obvious.…”

Section: The Role Of Antipsychotic Medicationmentioning

confidence: 99%

The symptom of depression in schizophrenia and its management

Mulholland¹,

Cooper²

2000

Adv. psychiatr. treat

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Depression is a frequently occurring symptom in schizophrenia. While today it is often underrecognised and under-treated, historically such symptoms were the focus of much attention. Affective symptoms were used by Kraepelin as an important criterion with which to separate dementia praecox from manic–depressive illness. Kraepelin also recognised the importance of depression as a symptom in schizophrenia and identified several depressive subtypes of the illness. Mayer-Gross emphasised the despair that often occurs as a psychological reaction to acute psychotic episodes and Bleuler considered depression to be one of the core symptoms of schizophrenia.

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Antipsychotic Drug-Induced Dysphoria

Abstract: While dysphoria is a well-recognized reaction in healthy volunteers, it is probably insufficiently recognised in patients, particularly if it occurs in the absence of akathisia. Better detection could improve compliance in patients.

Cited by 59 publications

References 14 publications

Immediate effects of droperidol

Immediate effects of droperidol

Typical and Atypical Antipsychotics – The Misleading Dichotomy

The symptom of depression in schizophrenia and its management

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