Neuroleptic dysphoria: revisiting the concept 50 years later.
OBJECTIVE
To review the concept of neuroleptic dysphoria, its historical development and the current state of the art.


METHODS
This paper is based on extensive but selective literature review and also draws on our extensive clinical and research experiences.


RESULTS
Although the construct of neuroleptic dysphoria was recognized shortly following the introduction of the first antipsychotic, chlorpromazine, it took several years for the concept to receive adequate research and clinical attention. Without having direct evidence to link neuroleptic dysphoria to dopamine, it was generally understood that dopamine played a significant role in its genesis. In recent neuroimaging studies and dopamine depletion strategies, the role of dopamine in the genesis of neuroleptic dysphoria has been directly confirmed.


CONCLUSIONS
Neuroleptic dysphoria is a valid construct, which has significant implications for treatment and outcome. It is now clear that it relates to dopamine activities in the nigrostriatal complex. Recent research has also raised the issue of whether neuroleptic dysphoria is a variant of extrapyramidal symptoms. Meanwhile, the role of dopamine in both the genesis of neuroleptic dysphoria and addictive behaviour has raised the issue of both conditions being different facets of the schizophrenic disease process. The recent interface of addiction and psychiatry research may have opened a new science: the science of subjective tolerability disorders.
Awad
A G
AG
Department of Psychiatry and The Institute of Medical Science, University of Toronto, and Humber River Regional Hospital, Toronto, ON, Canada. gawad@hrrh.on.ca
Voruganti
L N P
LN
D014150:Antipsychotic Agents / Q000009:adverse effects / Q000266:history* / Q000627:therapeutic use*; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D011570:Psychiatry / Q000266:history*; D012559:Schizophrenia / Q000188:drug therapy* / Q000266:history*; D016896:Treatment Outcome
D014150:Antipsychotic Agents