The Neuroleptic Dysphoria Syndrome

  • Theodore Van Putten
  • Stephen R. Marder
  • Nicole Chabert
Conference paper


In our experience, higher doses of neuroleptics are often associated with a dysphoria syndrome. We believe that this dysphoria is underrecognized, and that it is readily correctable by decreasing the dose. Naturalistic studies which compare depression ratings in patients on different doses of neuroleptics are not likely to support such a concept since dysphoric patients either leave treatment or tend to tolerate only a low dose. To study dose-related dysphoria, therefore, patients need to be randomly assigned to fixed doses of antipsychotic drug.


Brief Psychiatric Rate Scale Chronic Schizophrenia Acute Schizophrenia Fluphenazine Decanoate Emotional Withdrawal 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Prien RF, Cole JO: High dose chlorpromazine therapy in chronic schizophrenia. Arch Gen Psychiatry 18: 481–495, 1968.CrossRefGoogle Scholar
  2. 2.
    Prien RF, Levine J, Cole JO: High dose trifluoperazine therapy in chronic schizophrenia. Am J Psychiatry 126: 305–313, 1969.PubMedGoogle Scholar
  3. 3.
    Clark ML, Ramsey HR, Ragland RE, et al: Chlorpromazine in chronic schizophrenia: Behavioral dose-response relationships. Psychopharmacology (Berlin) 18: 260–270, 1970.CrossRefGoogle Scholar
  4. 4.
    Clark ML, Ramsey HR, Rahhal DK, et al: Chlorpromazine in chronic schizophrenia. Arch Gen Psychiatry 27: 479483, 1972.Google Scholar
  5. 5.
    Brotman RK, Muzekari LH, Shanken PM: Butaperizine in chronic schizophrenic patients: A double-blind study. Curr Ther Res 11: 5–8, 1969.PubMedGoogle Scholar
  6. 6.
    Carscallen HB, Rochman H, Lovegrove RD: High dosage trifluoperazine in schizophrenia. Can Psych Assoc J 13: 459–461, 1968.Google Scholar
  7. 7.
    Itil TM, Saletu B, Hu W, et al: Clinical and quantitative EEG changes at different dosage levels of fluphenazine treatment. Acta Psychiatr Scand 47: 440–451, 1971.PubMedCrossRefGoogle Scholar
  8. 8.
    Itil TM, Keskiner A, Heinemann L, et al: Treatment of resistant schizophrenics with extreme high dosage fluphenazine hydrochloride. Psychosomatics 11: 456–463, 1970.PubMedGoogle Scholar
  9. 9.
    Simpson GM, Amin M, Kurk-Bartholini E, et al: Problems in the evaluation of the optimal dose of phenothiazine (butaperazine). Dis New Syst 29: 478–484, 1968.Google Scholar
  10. 10.
    McClelland HA, Farquharson RG, Leyburn P, et al: Very high dose fluphenazine decanoate. A controlled trial in chronic schizophrenia. Arch Gen Psychiatry 33: 1435–1439, 1976.PubMedCrossRefGoogle Scholar
  11. 11.
    Glodstein MJ, Rodnick EH, Evans JR, et al: Drug and family therapy in the aftercare treatment of acute schizophrenia. Arch Gen Psychiatry 35: 1169–1177, 1978.CrossRefGoogle Scholar
  12. 12.
    Quitkin F, Rifkin A, Klein DF: Very high dosage vs standards dosage fluphenazine in schizophrenia. Arch Gen Psychiatry 32: 1276–1281, 1975.PubMedCrossRefGoogle Scholar
  13. 13.
    Wijsenbeck H, Steiner M, Goldberg SC: Trifluoperazine: A comparison between regular and high doses. Psychopharmacology (Berlin) 36: 147–150, 1974.CrossRefGoogle Scholar
  14. 14.
    Cole JO: Antipsychotic drugs: is more better? McLean Hosp J 7: 6–7, 1982.Google Scholar
  15. 15.
    Baldessarini RJ, Cohen BM, Teicher MH: Significance of neuroleptic dose and plasma level in the pharmacological treatment of psychosis. Arch Gen Psychiatry 45: 79–91, 1988.PubMedCrossRefGoogle Scholar
  16. 16.
    Baldessarini RJ, Katz B, Cotton P: Dissimilar dosing with high-potency and low-potency neuroleptics. Am J Psychiatry 141: 748–752, 1984.PubMedGoogle Scholar
  17. 17.
    Gelenberg AJ, Bellinghausen B, Wojcik JD, Falk WE, Sachs GS: A prospective survey of neuroleptic malignant syndrome in a short-term psychiatric hospital. Am J Psychiatry 145: 517–518, 1988.PubMedGoogle Scholar
  18. 18.
    Neborsky R, Janowsky D, Nurison E, Munson E, Depry D: Rapid treatment of acute psychotic symptoms with high and low-dose heloperidol. Arch Gen Psychiatry 38: 195–201, 1981.PubMedCrossRefGoogle Scholar
  19. 19.
    Eriksen SE, Hurt SW, Chang S: Haloperidol dose, plasma levels and clinical response: a double-blind study. Psychopharmacol Bull 14: 15–16, 1978.Google Scholar
  20. 20.
    Reschke R: Parental haloperidol for rapid control of severe, disruptive symptoms of acute schizophrenia. Dis Nery Sys 35: 112–115, 1974.Google Scholar
  21. 21.
    Modestin J, Toffler G, Pia E, Greub E: Haloperidol in acute schizophrenia inpatients: a double-blind comparison of two dosage regimens. Pharmacopsychiatria 16: 121–126, 1983.PubMedCrossRefGoogle Scholar
  22. 22.
    Donlon PT, Hopkin JT, Tupin JP, Wicks JJ, Wahaba M, Meadow A: Haloperidol for acute schizophrenia patients. An evaluation of three oral regimens. Arch Gen Psychiatry 37: 691–695, 1980.PubMedCrossRefGoogle Scholar
  23. 23.
    Overall J, Gorham D: Brief Psychiatric Rating Scale. Psych Rep 10: 799–812, 1962.CrossRefGoogle Scholar
  24. 24.
    Marder SR, Van Putten T, Mintz J, McKenzie J, Lebell M, Faltico G, May PRA: Costs and benefits of two doses of fluphenazine. Arch Gen Psychiatry 41: 1025–1029, 1984.PubMedCrossRefGoogle Scholar
  25. 25.
    Teicher MH, Baldessazrini RJ: Selection of neuroleptic dosage. Arch Gen Psychiatry 42: 636–637, 1985.PubMedCrossRefGoogle Scholar
  26. 26.
    Rifkin A, Quitkin F, Klein DF: Akinesia. Arch Gen Psychiatry 32: 672–674, 1975.CrossRefGoogle Scholar
  27. 27.
    Rifkin A, Kane JM: Low-dose neuroleptic maintenance treatment of schizophrenia, in Kane JM (ed): Drug Maintenance Strategies in Schizophrenia. Washington, DC, American Psychiatric Press, Inc, pp 14–29, 1984.Google Scholar
  28. 28.
    Kane JM, Rifkin A, Woerner M, Reardon G, Kreisman D, Blumenthal R, Borenstein M: High-dose versus low-dose strategies in the treatment of schizophrenia. Psychopharmacology Bull 21: 533–537, 1985.Google Scholar
  29. 29.
    Drake RE, Erhrlich J: Suicide attempts associated with akathisia. Am J Psychiatry 142: 499–501, 1985.PubMedGoogle Scholar
  30. 30.
    Shear K, Frances A, Weiden P: Suicide associated with akathisia and depot fluphenazine treatment. J Clin Psychopharmacol 3: 235–236, 1983.PubMedCrossRefGoogle Scholar
  31. 31.
    Weiden P: Akathisia from prochlorperazine. JAMA 253: 635, 1985.PubMedCrossRefGoogle Scholar
  32. 32.
    Van Putten T: The many faces of akathisia. Compr Psychiatry 16: 43–47, 1975.PubMedCrossRefGoogle Scholar
  33. 33.
    Keckia WA: Violence as a manifestation of akathisia. JAMA 240: 2185, 1978.CrossRefGoogle Scholar
  34. 34.
    Shaw ED, Mann JJ, Weiden PJ, Sinsheimer LM, Brunn RD: A case of suicidal and homicidal ideation and akathisia in a double-blind neuroleptic crossover study. J Clin Psychopharmacol 6: 196–197, 1986.PubMedCrossRefGoogle Scholar
  35. 35.
    Van Putten T, Mutalipassi LR, Malkin MD: Phenothiazine induced decompensation. Arch Gen Psychiatry 30: 102–105, 1974.PubMedCrossRefGoogle Scholar
  36. 36.
    Van Putten T, Mutalipassi LR: Fluphenazine enanthale induced decompensation. Psychosomatics 16: 37–40, 1975.PubMedGoogle Scholar
  37. 37.
    Van Putten T, May PRA: “Akinetic depression” in schizophrenia. Arch Gen Psychiatry 35: 1101–1107, 1978.PubMedCrossRefGoogle Scholar
  38. 38.
    Donlon PT: High dosage neuroleptic therapy: A review. Int Pharmacopsychiatry 11: 235–245, 1976.PubMedGoogle Scholar
  39. 39.
    Ayd FJ Jr: Haloperidol update: 1975. Proc R Soc Med 69: 14–22, (Suppl 1), 1976.Google Scholar
  40. 40.
    McEvoy JP, Stiller RL, Farr R: Plasma haloperidol levels drawn at neuroleptic threshold doses: A pilot study. J Clin Psychopharmacol 6: 133–137, 1986.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1989

Authors and Affiliations

  • Theodore Van Putten
    • 1
  • Stephen R. Marder
    • 1
  • Nicole Chabert
    • 1
  1. 1.Veterans Administration Medical CenterPsychiatry DivisionLos AngelesUSA

Personalised recommendations