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

Objective: Subjective reports of dysphoric responses to neuroleptic medicat ion 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 sym ptomatology 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 signif icant proportion of the variance (R = 0.53, R-2 = 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 negativ e symptoms of the illness or due to other factors such as depression, we ra ise the possibility that they may be clinically indistinguishable from, and be a subjective measure of, the so-called 'neuroleptic-induced deficit syn drome'. (C) 1999 Editions scientifiques et medicales Elsevier SAS.