The paradox of care: dopamine super sensitivity psychosis and catatonia following excessive antipsychotic exposure in an adolescent with first-break schizophrenia

Parinda Parikh; Dilinuer Wubuli; Ananya Reddy Dadem; Isa Gultekin; Arushi Chandra-Kaushik; Eric Wang; Rithika Narravula; Avish Chandra; Ishant Buddhavarapu; Avigder Mendelowitz

doi:10.18203/2394-6040.ijcmph20253283

Authors

Parinda Parikh Department of Psychiatry, Weill Cornell Medical College, White Plains, USA
Dilinuer Wubuli Department of Neurology, Toronto Western Hospital, Ontario, Canada
Ananya Reddy Dadem SVIMS- Sri Padmavathi Medical College for Women, Andhra Pradesh, India
Isa Gultekin Department of Family Medicine, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale, Turkey
Arushi Chandra-Kaushik NYU Steinhardt School of Culture, Education, and Human Development, New York, USA
Eric Wang Edgemont Jr. Sr. High School, New York, USA
Rithika Narravula University of Pittsburgh, Pennsylvania, USA
Avish Chandra 2ND ARC Associates, White Plains, USA
Ishant Buddhavarapu Iona Preparatory High School, New Rochelle, New York, USA
Avigder Mendelowitz Long Island University, NY, USA

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20253283

Keywords:

Dopamine super sensitivity psychosis, Catatonia, Antipsychotic, Schizophrenia, Clozapine

Abstract

Dopamine super sensitivity psychosis (DSP) is marked by rebound or treatment-resistant psychosis, typically linked to prolonged or poorly managed antipsychotic use. While increasingly recognized in adults, DSP in adolescents, especially with catatonia, remains underreported. The impact of fragmented psychiatric care and caregiver-driven treatment changes is rarely addressed. We describe a 13-year-old female with schizophrenia who developed severe functional decline and catatonia after years of inconsistent psychiatric management. Extensive workup, including EEG, brain MRI, and broad metabolic, infectious, autoimmune, and endocrine testing, was negative. Her history revealed frequent physician changes and abrupt medication switches without tapering, often initiated by parental concern over persistent symptoms. At presentation, she was wheelchair-bound, minimally responsive, and showed psychomotor retardation, tremors, and auditory hallucinations. Her course aligned with DSP complicated by catatonia, after incomplete or subtherapeutic trials of risperidone, olanzapine, quetiapine, aripiprazole, and cariprazine. Treatment with clozapine and high-dose lorazepam was initiated, alongside careful monitoring and structured support for the family. The patient gradually regained independence, resumed psychotherapy, and re-engaged socially, with significant improvement in psychosis. This case illustrates the rare intersection of adolescent DSP and catatonia, highlighting risks of inconsistent treatment and caregiver-driven decisions. It underscores the importance of coordinated psychiatric care, cautious medication adjustments, and comprehensive family education. Supporting caregivers emotionally and educationally is vital to improving adherence and long-term outcomes for youth with severe mental illness.

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