Neuroleptic-induced deficit syndrome

Neuroleptic-induced deficit syndrome (NIDS) is a psychopathological syndrome that develops in some patients who take high doses of a neuroleptic (antipsychotic) drug for an extended time.[1] It is most often caused by high-potency typical antipsychotics, but can also be caused by high doses of many atypicals, especially those closer in profile to typical ones (that have higher D2 dopamine receptor affinity and relatively low 5-HT2 serotonin receptor binding affinity), like paliperidone and amisulpride.[2]

Symptoms

Neuroleptic-induced deficit syndrome is principally characterized by the same symptoms that constitute the negative symptoms of schizophrenia: emotional blunting, apathy, hypobulia, anhedonia, indifference, difficulty or total inability in thinking, difficulty or total inability in concentrating, lack of initiative, attention deficits, and desocialization.[2] This can easily lead to misdiagnosis and mistreatment. Instead of decreasing the antipsychotic, the doctor may increase their dose to try to "improve" what they perceive to be negative symptoms of schizophrenia, rather than antipsychotic side effects. The concept of neuroleptic-induced deficit syndrome was initially presented for schizophrenia, and it has rarely been associated in other mental disorders.[2] In recent years, atypical neuroleptics are being more often managed to patients with bipolar disorder, so some studies about neuroleptic-induced deficit syndrome in bipolar disorder patients are now available.[2]

There are significant difficulties in the differential diagnosis of primary negative symptoms and neuroleptic deficiency syndrome (secondary negative symptoms), as well as depression.[3]

History

Before the term NIDS was coined, the cluster of signs and symptoms was described using various labels such as "drug-induced akinesia", "neuroleptic dysphoria", "neuroleptic-induced anhedonia" and "pharmacogenic depression". Arthur Rifkin and his colleagues were among the first to systematically describe the key symptoms now associated with NIDS in their 1975 paper "Akinesia: A Poorly Recognized Drug-Induced Extrapyramidal Behavioral Disorder".[4] The specific term "neuroleptic-induced deficit syndrome" was proposed later by Malcolm Lader with his 1993 paper titled "Neuroleptic-induced deficit syndrome: old problem, new challenge".[1] A 1995 Polish review article by T. Szafrański explicitly states: "For the drug-related impairment... the name of neuroleptic-induced deficit syndrome (NIDS) is proposed",[5] which supports that the term was formally entering psychiatric literature in the mid-1990s.

Cases

A Japanese man, who was being treated for schizophrenia, exhibited neuroleptics-induced deficit syndrome and obsessive–compulsive symptoms.[6] His symptoms were remarkably improved by quitting a course of antipsychotics followed by the introduction of the antidepressant fluvoxamine.[6] He had been misdiagnosed with schizophrenia, the real diagnosis was obsessive–compulsive disorder.[6]

From June 2023 to April 2024, Serbian television presenter Bojana Nikolić Janković, known for hosting the show City, posted to the internet forum Bluelight that she was bedridden with anhedonia, cognitive issues, low energy and other symptoms consistent with neuroleptic-induced deficit syndrome after receiving six depot injections of paliperidone palmitate (i.e. four shots of Invega Sustenna® and two shots of Invega Trinza®), prescribed due to stress related to her divorce from Ognjen Janković, a member of the hip-hop group Beogradski Sindikat.[7][8] She died by suicide in Belgrade on April 19, 2024, aged 46.[9]

See also

References

  1. ^ a b Lader, Malcolm Harold (1993). "Neuroleptic-Induced Deficit Syndrome (NIDS)". Journal of Clinical Psychiatry. 54 (12): 493–500. PMID 7903967.
  2. ^ a b c d Ueda S, Sakayori T, Omori A, Fukuta H, Kobayashi T, Ishizaka K, et al. (2016). "Neuroleptic-induced deficit syndrome in bipolar disorder with psychosis". Neuropsychiatr Dis Treat. 12: 265–268. doi:10.2147/NDT.S99577. PMC 4745952. PMID 26893564.
  3. ^ Barnes TR, McPhillips MA (1995). "How to distinguish between the neuroleptic-induced deficit syndrome, depression and disease-related negative symptoms in schizophrenia". Int Clin Psychopharmacol. 10 (Suppl 3): 115–121. doi:10.1097/00004850-199509000-00015. PMID 8866773. S2CID 25586101.
  4. ^ Rifkin, A., Quitkin, F., & Klein, D. F. (1975). A poorly recognized drug-induced extrapyramidal behavioral disorder. Archives of General Psychiatry, 32(5), 672–674. https://doi.org/10.1001/archpsyc.1975.01760230138011 (https://psycnet.apa.org/doi/10.1001/archpsyc.1975.01760230138011)
  5. ^ Szafrański T. Poneuroleptyczny zespół ubytkowy [Neuroleptic induced deficit syndrome]. Psychiatr Pol. 1995 May-Jun;29(3):359-69. Polish. PMID: 7652089.
  6. ^ a b c Machida N, Shiotsuka S, Semba J (2005). 強迫性障害と抗精神病薬による欠陥症候群(NIDS)の合併例に抗精神病薬中止とSSRIが奏効した一例 [Case of obsessive-compulsive disorder associated with neuroleptics-induced deficit syndrome (NIDS): successfully treated by discontinuation of neuroleptics followed by SSRI.]. 精神神経学雑誌 [Seishin Shinkeigaku Zasshi] (in Japanese). 107 (7): 667–673. PMID 16146185.
  7. ^ bojana, post to "Coming off Invega/Xeplion (paliperidone) injections v 8.0," Bluelight, December 24, 2023, https://www.bluelight.org/community/threads/coming-off-invega-xeplion-paliperidone-injections-v-8-0.934528/post-15958591. "So im 10 months off. I have some emotions, i can cry, lost weight, listen to some music. My main problem is 0 motivation, low energy and anhedonia. Also i have cognitive issues. Beddriden mostly.. When do you think it will go away? Im loosing hope"
  8. ^ bojana, post to "Coming off Invega/Xeplion (paliperidone) injections v 8.0," Bluelight, March 3, 2024, https://www.bluelight.org/community/threads/coming-off-invega-xeplion-paliperidone-injections-v-8-0.934528/post-16002558. "They really killed everything in me and about me, im different person who suffers enormasly every day. I juste believed medical doctros and their knowledge. […] I dont accept undignefied life, i was mother, jurnalist, tv host, happiest women ever who adored life, kids, family, friends. Everything is gone. Everything. Somehow deep in my heart i have small hope of being my self again, its just that i am tiered and i had way to much suffering. Life is not worth living anymore, and i cant allowe everybody around me to suffer with me. Id rather be dead, than be this person who i have become."
  9. ^ "DECU POSLALA IZ KUĆE, PA OTIŠLA U SMRT! Isplivali novi detalji o Bojani Nikolić! Ugovarala jednu stvar sa sestrom, žalila se NA OVE SIMPTOME!". Republika.rs (in Serbian). April 22, 2024. Retrieved November 6, 2025.
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