Neuroleptic-Induced Dopamine Supersensitivity Psychosis (DSP)

Neuroleptic-Induced Dopamine Supersensitivity Psychosis (DSP) was a concept first introduced by psychiatrist Guy Chouinard in 1980.^[1]

• The hypothesis is that chronic antipsychotic use leads to the upregulation of dopamine (D2) receptors in the basal ganglia (and thus, tardive dyskinesia).
• Further, is it also characterized by tolerance to increasing doses of antipsychotic.
• Finally, most clinically relevant is the hypothesis that rebound psychosis could occur with a reduction or discontinuation of the antipsychotic (separate from the underlying disease course itself).

• The idea that neuroleptic-induced dopamine supersensitivity psychosis could be iatrogenic is re-emerging in the research literature. This is a controversial, but clinically relevant concept that requires ongoing research because the clinical impact could be significant.

• Thompson, I. A., de Vries, E. F., & Sommer, I. E. (2020). Dopamine D2 up-regulation in psychosis patients after antipsychotic drug treatment. Current opinion in psychiatry, 33(3), 200-205.
• Turkheimer, F. E., Selvaggi, P., Mehta, M. A., Veronese, M., Zelaya, F., Dazzan, P., & Vernon, A. C. (2020). Normalizing the Abnormal: Do Antipsychotic Drugs Push the Cortex Into an Unsustainable Metabolic Envelope?. Schizophrenia bulletin, 46(3), 484-495.
• Yin, J., M Barr, A., Ramos-Miguel, A., & M Procyshyn, R. (2017). Antipsychotic induced dopamine supersensitivity psychosis: a comprehensive review. Current neuropharmacology, 15(1), 174-183.
• Chouinard, G., Samaha, A. N., Chouinard, V. A., Peretti, C. S., Kanahara, N., Takase, M., & Iyo, M. (2017). Antipsychotic-induced dopamine supersensitivity psychosis: Pharmacology, criteria, and therapy. Psychotherapy and psychosomatics, 86(4), 189-219.
• Bowtell, M., Ratheesh, A., & O'Donoghue, B. (2018). Response to Lex Wunderink's query as to whether the development of supersensitivity could explain the greater risk of relapse in individuals with a longer duration of treatment with antipsychotic medication. Schizophrenia research.
• Emsley, R. (2017). On discontinuing treatment in schizophrenia: a clinical conundrum.
• Moncrieff, J. (2006). Does antipsychotic withdrawal provoke psychosis? Review of the literature on rapid onset psychosis (supersensitivity psychosis) and withdrawal‐related relapse. Acta Psychiatrica Scandinavica, 114(1), 3-13.