Dysphoric subjective response to neuroleptics in schizophrenia: relationship to extrapyramidal side effects and symptomatology

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Abstract
Summary: Objective: Subjective reports of dysphoric responses to neuroleptic medication are common in clinical practice. However, cognitive and affective side effects of neuroleptic medications are difficult to differentiate from the symptoms of schizophrenia. We sought to elucidate the relative contribution of extrapyramidal side effects and symptomatology to dysphoric response.Method: Fifty clinically stable outpatients with schizophrenia attending a rehabilitation centre were assessed for extrapyramidal side effects and symptomatology before completing the drug attitude inventory (DAI).Results: Presence of extrapyramidal side effects, found in 28 patients (Z = −1.99, p = 0.05), and severity of negative symptoms (r = −0.47, p = 0.001) were independently associated with dysphoric response, explaining a significant proportion of the variance (R = 0.53, R2 = 25.2%, F = 9.27, df = 2, p = 0.0004).Conclusions: Patients who report a dysphoric response which they associate with neuroleptic medications have more extrapyramidal side effects and more severe negative symptoms. While these responses may be part of the negative symptoms of the illness or due to other factors such as depression, we raise the possibility that they may be clinically indistinguishable from, and be a subjective measure of, the so-called ‘neuroleptic-induced deficit syndrome’.