Efficacy of Asenapine in Drug-resistant Psychotic Patients with Dopamine Supersensitivity Psychosis: Two Cases

Abstract

Dopamine supersensitivity psychosis (DSP) is an unstable clinical condition observed in individuals with schizophrenia who have been treated with an antipsychotic medication at a high dosage and/or for a long period. An up-regulation of dopamine D2 receptors (DRD2) is thought to be involved in the essential pathology of DSP. An antipsychotic agent with both tight binding to DRD2 and a long half-life is generally effective for treating DSP, but a patient who meets the criteria of treatment-resistant schizophrenia sometimes needs treatment with clozapine. We report the case details of two patients whose DSP was not controlled with several antipsychotics but was successfully controlled with asenapine. Asenapine binds to a broad range of dopamine receptors and serotonin receptors, and it is thus distinct from other atypical antipsychotics. The unique profile of asenapine may contribute to the control of severe DSP symptoms in individuals with schizophrenia.

Predictors of continuation for asenapine from real-world data in patients with schizophrenia

“…However, unlike other drugs, asenapine has the unique pharmacological property of having a greater a nity for a variety of receptors involved in the pathology of schizophrenia 23) . Recently, accumulating evidence suggests that asenapine is highly e cacious for patients with treatment-resistant schizophrenia 24,25) or dopamine supersensitivity psychosis 26) . The potential reason for this is the full antagonist activity against dopamine D2 and serotonin 2A receptors.…”