Elsevier

Biological Psychiatry

Volume 25, Issue 1, 1 January 1989, Pages 75-86
Biological Psychiatry

Alterations in sleep polygraphy after neuroleptic withdrawal: A putative supersensitive dopaminergic mechanism

https://doi.org/10.1016/0006-3223(89)90149-2Get rights and content

Abstract

Although a number of studies have reported sleep disturbances following neuroleptic withdrawal, a full description of such changes in sleep architecture is not available. Polysomnographic, plasma prolactin, and clinical measurements were carried out in a small number of patients on chronic neuroleptic treatment and after drug withdrawal. Preliminary findings show that in these chronically treated schizophrenic patients with and without tardive dyskinesia (TD), abrupt neuroleptic withdrawal induces reductions in total sleep, rapid eye movement (REM) sleep, and plasma prolactin. Furthermore, an increase in delta sleep was observed only in patients without TD. The REM suppression occurred significantly earlier in TD patients compared to the non-TD schizophrenic patients. These changes were transient, and both sleep measures and plasma prolactin stabilized during the 2–4 weeks after withdrawal to levels somewhere between the values observed during chronic treatment and withdrawal (week 1) periods. As the withdrawalinduced exaggerated changes mimicked the dopamine agonist effect on these sleep and hormonal measures, one can hypothesize that the observed changes are due to unmasking of supersensitive dopamine receptors following drug cessation. Normalization of these receptors and/or adaptational changes in other nondopaminergic system(s) can hypothetically explain the eventual stabilization of these measures during the following weeks.

References (41)

  • GW Brooks

    Withdrawal from neuroleptic drugs

    Am J Psychiatry

    (1959)
  • C Cianchetti et al.

    Suppression of REM and delta sleep by apomorphine in man: A dopamine mimetic effect

    Psychopharmacology

    (1980)
  • G Chouinard et al.

    Neuroleptic-induced supersensitivity psychosis: Clinical and pharmacologie characteristics

    Am J Psychiatry

    (1980)
  • JL DeRivera et al.

    Effect of acute and chronic neuroleptic therapy on serum prolactin levels in men and women of different age groups

    Clin Endocrinol (Oxford)

    (1976)
  • JC Gillin et al.

    REM inhibitory effect of L-DOPA infusion during human sleep

    Electroencephal Clin Neurophysiol

    (1973)
  • JC Gillin et al.

    What is the role of dopamine in the regulation of sleep-wake activity?

  • LM Greenberg et al.

    Differential effects of abrupt versus gradual withdrawal of chlorpromazine in hospitalized chronic schizophrenic patients

    Am J Psychiatry

    (1966)
  • E Hartmann et al.

    The effects of long-term administration of psychotropic drugs on human sleep. IV. The effects of chlorpromazine

    Psychopharmacology

    (1973)
  • J Hyttel et al.

    Receptor-binding profiles of neuroleptics

  • K Jus et al.

    Sleep analysis during drug-free weekends in chronic schizophrenic patients

    Biol Psychiatry

    (1976)
  • Cited by (0)

    Supported in part by NIMH Grants RO3 MH40641-O1, RO1 MH37073-O1A1 and MH35996.

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