Korean J Schizophr Res.  2023 Apr;26(1):1-11. 10.16946/kjsr.2023.26.1.1.

Breakthrough Psychosis and Long-Acting Injectable Antipsychotics

• Joo EJ
• Lee KY
• Jeong SH
• Kim YS

• KMID: 2542194
• DOI: http://doi.org/10.16946/kjsr.2023.26.1.1

Abstract

“Breakthrough” of psychosis despite good compliance of antipsychotics medication for a long time is a major obstacle to the treatment of schizophrenia, whether the mechanism is caused by dopamine hypersensitivity or insufficient dose of antipsychotics. Researchers advocating “Dopamine Supersensitivity Psychosis” (DSP) emphasize to avoid excessive inhibition of dopamine 2 receptors from the beginning of treatment. On the other hand, researchers advocating “Breakthrough psychosis on Antipsychotic Maintenance Medication” (BAMM) in which psychosis recurs due to insufficient medication despite continuous administration of antipsychotics without non-adherence argue that dose of antipsychotics should be increased to enhance therapeutic effect. In patients using long-acting antipsychotics injection (LAI), non-compliance can be ruled out. We believe that in treating non-affective psychosis, it is necessary to continuously maintain the lowest dose possible using the optimal dose considering the side effects of second-generation antipsychotics and the cycle and stage of psychosis, and the optimal formulation such as LAI.

Keyword

Antipsychotics; Breakthrough psychosis (BAMM); Dopamine supersensitivity psychosis (DSP); Long-acting injectable antipsychotics (LAI); Schizophrenia; 도파민 초민감성 정신병; 돌파정신병; 조현병; 항정신병약물 장기지속형 주사제; 항정신병약물