Supersensitivity psychosis following clozapine discontinuation: Myth or reality

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7.5t 211.53 mg/d in the risperidone group and 476.54±476.90 mg/d in the group with conventional antipsychotics . The pointprevalence of akathisia was 7.3% in the clozapine group. 13% in the risperidone group and 23.8% in the group with conventional antipsychotics. The point-prevalence of cogwheel-rigidity was 2.4% in the clozapine group. 17.4% in the risperidone group and 26.2%in the group with conventional antipsychotics. The highest prevalence of rigidity was found in the group treated with conventional antipsychotics with 35.7% versus 17.4% in the risperidone group and 4.9"10 in the clozapine group. Our results indicate, that risperidone is superior to conventional neuroleptics in regard to EPS. In comparison to clozapine, risperidone produce EPS levels that are intermediate between clozapine and conventional antipsychotic drugs.

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SUPERSENSITIVITY PSYCHOSIS FOLLOWING CLOZAPINE DISCONTINUATION: MYTH OR REALITY Steven G . Potkin, Julie Oldroyd, Yi Jin, Bala Gulasekaram, Jerome Costa, Jennifer Telford Department of Psych iatry. University of California. Irvine, Irvine. CA 92697

Supersensitivity psychosis (SSP) is the sudden and dramatic worsening of and/or the development of new psychotic symptoms following the abrupt discontinuation of antipsychotic medication. Several case reports suggests that SSP may be more severe or frequent following rapid clozapine discontinuation. Twenty-nine chronic refractory schizophrenic patients were stud ied after abrupt withdrawal of standard neuroleptics, clozapine and /or haloperidol. SSP was operationally defined as a greater than 40% worsening of BPRS scores. One week after discontinuation of haloperidol, no (0%) patients developed SSP compared to 36% of c1ozapine-treated patients (Fisher exact test p~O .OI6). At the end of the second week of discontinuation, 27% of haloperidol patients experienced SSP compared to 36% of clozapine-treated patients (Fisher exact test p= 0.70). Clinical response differed among the three treatments, with clozapine showing greater improvement than standard neuroleptics and haloperidol (F (2, 56)=4.33, p0.24). In conclusion, approximately 30% of these chronic schizophrenic patients developed SSP within 2 weeks after abrupt discontinuation of their antipsychotic medications. Patients discontinued from clozapine experienced a more rapid and greater exacerbation (in terms of percentage change) from their prediscontinuation state; however, by the end of the second week of discontinuation, the number of patients who developed SSP and the severity of the SSP was equal for all treatments. In 58 discontinuations, no patients developed new symptoms. Further, no patient experienced a significantly greater severity of psychosis following abrupt clozapine discontinuation than after abrupt discontinuation from standard neuroleptics and haloperidol.

EFFECTS OF LOW VERSUS HIGH POTENCY NEUROLEPTIC WITHDRAWAL ON SYMPTOMS AND DYSKINETIC MOVEMENTS S.K. Schultz. D .D. Miller, S. Arndt, N.C. Andreasen University ofIowa Department ofPsychiatry. 200 Hawk ins Drive, Iowa City. IA 52242

Patients are increasingly undergoing transition from older typical agents to novel antipsychotics, lending greater relevance to our understanding of emergent symptoms associated with neuroleptic discontinuation. We have previously reported increased negative and disorganized symptoms during withdrawal. This study examined the impact of high versus low potency medication withdrawal on symptom and dyskinesia measures. Forty-eight patients with schizophrenia discontinued medications for three weeks. Patients who discontinued a low potency neuroleptic (e.g, chlorpromazine or mellaril) were compared to those who discontinued haloperidol (high potency). We observed an increase in dyskinetic movements, negative and disorganized symptoms, but no differencein positive symptoms. Further, we assessed the effects high versus low potency withdrawal , showing a significant effect of low, but not high, potency with increased positive symptoms. There was no effect of potency in AIMs or other symptoms. When duration of treatment and age were covaried with potency as potential influences on dyskinesia, there was a significant effect of age and an interactive effect of age and potency with increased dyskinesia. This suggests a possible relationship between discontinuation of low potency antipsychotics and emergence of positive symptoms. Further there may be a greater likelihood of increased dyskinetic movements with age during neuroleptic withdrawal.

7S1 CHRONIC NEUROLEPTIC DRUG TREATMENT INDUCES MILD GLIOSIS IN THE PREFRONTAL CORTEX OF RHESUS MONKEYS Lynn D. Selemon, Michael S. Lidow, Patricia S. Goldman-Rakic Sect. ofNeurob iology, Yale Univ. Sch. Med; New Haven. CT065/O

Neuroleptics are prescribed extensively to alleviate psychosis in schizophrenic patients yet the impact of long-term drug treatment on cortical architecture is not known. In the present study, 17 monkeys received daily, oral doses of typical (TN: haloperidol , N = 2; pimozide, N = 2; chlorpromazine, N = 2) or atypical neuroleptics (AN: clozapine, N =2; olanzepine, N=2. risperidone, N = 2) or placebo (PC : N = 5) for 6 months.