Long-Term Neuroleptic Toxicity and Mood: Blurring of Diagnostic Boundaries
Exposure to neuroleptics results in long-term toxic syndromes, the most well described being tardive dyskinesia. Although schizophrenic patients are most prone to develop tardive dyskinesia because they are exposed to neuroleptics more frequently and for longer duration, evidence suggests that patients suffering from mood disorders may have a significant propensity towards developing tardive dyskinesia (1–11). The converse of this hypothesis, whether long-term neuroleptic exposure can in turn lead to symptoms resembling a mood disorder has been less extensively studied (12). In other words, can a patient, independent of diagnosis, develop long-term neuroleptic toxicity that will result in depression, lability of mood and other symptoms usually associated with a depressive syndrome. This paper will examine this hypothesis from the perspective of three types of mechanisms by which depression or depressive symptoms could develop in response to long-term neuroleptic toxicity. These three mechanisms are: 1) disfigurement with depression as a secondary reaction psychologically to the development of a tardive syndrome such as disfiguring tardive dyskinesia; 2) dysfunction with depression as a secondary effect physiologically to the development of a tardive syndrome such as respiratory dyskinesia or self-induced water intoxication syndrome (SIWIS); and 3) damage with depression, the result of a primary direct toxic effect putatively induced through damage to the frontal lobes.
KeywordsPositron Emission Tomography Schizophrenic Patient Tardive Dyskinesia Corpus Striatum Water Intoxication
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