A Prospective, Multicenter Study of Patients' Refusal of Antipsychotic Medication

Changes in Muscle Tone Are Regulated by D1 and D2 Dopamine Receptors in the Ventral Striatum and D1 Receptors in the Substantia Nigra

“…Further, it has been estimated that up to 30% of patients stop taking their medication because of these motor side effects (Hoge et al 1990). It is not fully understood why antipsychotic drugs, all antagonists at the dopamine D2 receptor (Creese et al 1976;Seeman et al 1976; Peroutka and Snyder 1980) produce motor side effects, although there is some early experimental evidence supporting the view that antagonism of D2 receptors in the striatum is important (Chiodo and Bunney 1983;Creese 1983).…”

Raclopride and Chlorpromazine, but not Clozapine, Increase Muscle Rigidity in the Rat Relationship with D2 Dopamine Receptor Occupancy

“…These include acute dystonic reactions which appear early in treatment and are characterized by intense contractions of antagonistic muscles, and Parkinson-like side effects which include muscle rigidity and hypokinesia (Ayd 1961). It has been reported that 35% of drug noncompliance is due to the unacceptability of the side effects associated with antipsychotic drug treatment (Hoge et al 1990) and this has stimulated a search for effective antipsychotic drugs which do not produce extrapyramidal side effects.The likelihood of extrapyramidal side effects developing appears to be dependent on the affinity of the antipsychotic drug for D 2 dopamine receptors (Creese et al 1976;Seeman et al 1976) so that there is a greater incidence associated with the high-potency drugs such as haloperidol and a lesser incidence with low-potency drugs such as chlorpromazine. Support for the view that there may be an association between the appearance of extrapyramidal side effects and D 2 receptor occupancy has come from positron emission tomography (PET) studies in humans (Farde and Nördström 1992a;Farde et al 1992b Farde et al , 1992cNyberg et al 1995).…”

“…These include acute dystonic reactions which appear early in treatment and are characterized by intense contractions of antagonistic muscles, and Parkinson-like side effects which include muscle rigidity and hypokinesia (Ayd 1961). It has been reported that 35% of drug noncompliance is due to the unacceptability of the side effects associated with antipsychotic drug treatment (Hoge et al 1990) and this has stimulated a search for effective antipsychotic drugs which do not produce extrapyramidal side effects.…”

Prospective study of patients' refusal of antipsychotic medication under a physician discretion review procedure

“…Under a system of judicial review of treatment refusal, patients may be able to negotiate changes in their medication regimens or to persuade psychiatrists that antipsychotic medications are not necessary. Support for this contention appears in findings from a prospective study of treatment refusal in Massachusetts, a jurisdiction that employs a rightsdriven model (23). In that study, Hoge et al found a refusal rate of 7.2% among newly admitted psychiatric patients.…”

“…The latter group may be sizable: in the most comprehensive study of treatment refusal conducted to date, only 18% of patients who refused treatment reached formal judicial review (23).…”