Adolescent female with withdrawal psychosis following abrupt termination of ziprasidone

Abstract

It is widely known that discontinuation reactions can occur after neuroleptics are stopped resulting in dyskinesia through its effect on the nigrostriatal pathway. Less discussed is the concept of "supersensitivity psychosis" which has been described as a rapid onset of psychosis after a neuroleptic medication has been withdrawn. Although the concept of supersensitivity psychosis has been described with the discontinuation of some neuroleptics, it has not been described with ziprasidone. Furthermore, the following case report is the first time that this phenomenon has been described in an adolescent patient who has discontinued ziprasidone. Reasons for supersensitivity psychosis are explored in addition to suggestions about precautions about prescribing neuroleptics in young people.

Supersensitivity Psychosis and Its Response to Asenapine in a Patient with Delusional Disorder

“…In our patient, the likely offending agent was ziprasidone. Ziprasidone-induced supersensitivity psychosis has been reported earlier in an adolescent, though the time course of symptoms differed from that seen in our case [ 14 ]. Certain aspects of our patient's phenomenology are strikingly similar to earlier reports; for example, both thought alienation [ 18 ] and persecutory delusions [ 1 , 12 ] have been documented in earlier cases of supersensitivity psychosis.…”

“…Supersensitivity psychoses have been most commonly reported in patients with schizophrenia [ 1 , 2 , 4 – 7 ], though documented cases have also been reported in schizoaffective disorder [ 8 ], in bipolar disorder [ 9 , 10 ], in intellectual disability [ 11 ], and even in subjects with no past history of mental illness [ 12 ]. Though its existence has been disputed by some authors [ 13 ], there has been a renewed interest in this condition with the realization that even newer “atypical” antipsychotics may be implicated in its causation [ 8 , 14 ]. Criteria for its diagnosis have been developed by Fallon et al [ 6 , 15 ], based on both Chouinard's descriptions and further research.…”