Die initial dysphorische Reaktion (IDR) auf die Ersteinnahme von Neuroleptika

Abstract

Initial dysphoric response (IDR) is characterized by a negative affective reaction within 48 h after a neuroleptic test dose. Currently, there are three scales for measuring the IDR (Neuroleptic Dysphoria Scale, Dysphoric Response Index, Drug Attitude Inventory). The debate continues about the definition, measurement, and underlying aetiology of IDR. Nevertheless, with a prevalence of 30%, the response is a clinically relevant phenomenon. Empirical data give some evidence of an association between IDR and short-term outcome. No correlation of IDR with pretreatment variables has been found yet (e.g. age, gender, and psychopathology at baseline, especially depression and hostility). With respect to aetiology, a negative subjective reaction to concurrent extrapyramidal side effects and direct dysaffective effects of some neuroleptics have been discussed. Other studies found that IDR might not be a specifically antipsychotic effect. Our first results give some evidence that patients treated with atypical antipsychotics experience IDR less often and less severely than those treated with conventional antipsychotics described in the literature. Further research should include placebo-controlled studies and the evaluation of specific pretreatment variables. To assess the aetiology of IDR, further basic research is needed.

Remission of severely impaired subjective wellbeing in 727 patients with schizophrenia treated with amisulpride

“…SW could be seen as a broad measure of subjective distress/experience negatively correlated with i) the severity of illness in general (7) and with various psychopathological symptoms/syndromes in particular, e.g. positive‐ and negative‐ (7–11), cognitive‐ (12), depressive syndromes (7–11, 13, 14), and anxiety (10, 14), with ii) antipsychotic side‐effects (SE, 15–19), especially with even mild extrapyramidal motor symptoms (EPMS; 9, 15–17), with psychic SE including sedation (15, 16) and dysphoria (5, 18), with sexual dysfunctions (15), and weight gain (19), with iii) the reward system including loss of motivation or lack of spontaneity (20), and with iv) suicidal behavior (21). It is therefore not surprising that SW is positively correlated with medication adherence and quality of life itself (1, 2) and that it could be viewed as an overall subjective measure of illness experience, (antipsychotic) treatment response, and life satisfaction (2, 4, 21).…”