2029 – Aripiprazole Withdrawal And Supersensitivity Psychosis: a Case Report

Abstract

Introduction

Supersensitivity psychosis is a drug-induced phenomenon which consists of psychotic relapse occurring upon decrease or withdrawal of antipsychotics. This phenomenon has been described with many antipsychotics. We report the case of supersensitivity psychosis associated with decreasing doses of aripiprazole in a Tunisian patient.

Case description

Mr. M. is a 26-year old Tunisian male with a diagnosis of bipolar disorder (DSM IV). He was diagnosed at the age of 17. For the last 2 years, his condition was stable with lithium 250 mg/day, valproic acid 500 mg/day and aripiprazole 15 mg/day. The patient had a good adherence to this regimen and could go to work and study. During that period he only had some depressive relapses. He never had psychotic symptoms. He decided himself to stop taking aripiprazole. The withdrawal was abrupt. Two days later, he began to experience auditory and visual hallucinations and persecutory delusion he never experienced before. He was hospitalized and he was put again on aripiprazole with increased doses to 20 mg/day. One week later his symptoms had improved significantly, he was experiencing less hallucinations. Two weeks later all the psychotic symptoms disappeared.

Discussion

This case illustrates the concept of supersensitivity psychosis. This concept refers to the proposal that chronic administration of dopamine-blocking agents increases sensitivity of dopamine receptors in the mesolimbic or mesocortical system. These dopamine-blocking agents over-react to normal levels of dopamine after drug discontinuation or reduction, thus producing psychotic symptoms, analogous to the proposed mechanism of tardive dyskinesia.