Nevins D B
Int J Psychoanal Psychother. 1977;6:227-41.
Negative therapeutic reactions to neuroleptics in schizophrenic patients are examined from the psychoanalytic perspective through case examples. Intrapsychic changes resulting from this medication, ordinarily considered beneficial, are shown, in some cases, to be disruptive of schizophrenic functioning and organization and potentially to endanger the continuation of medication itself. Changes are described which effect defenses, object relations, psychotic restitution, use of external reality, body image and cognition, and the symbolic significance of medication. Alterations in narcissistic ego states and disruption in preconscious processes, superimposed upon defective ego functioning, are used as explanatory concepts. These interact with transference based responses; in some cases, important psychodynamic issues emerge amenable to transference interpretations. Further study of intrapsychic changes may be useful in delineating a previously inexplicable response, understanding symptom formation, recognizing shifts in the patient-psychotherapist relationship, and forestalling premature cessation of medication.
通过案例分析，从精神分析的角度审视了精神分裂症患者对神经阻滞剂的负面治疗反应。这种通常被认为有益的药物所导致的内心变化，在某些情况下，会破坏精神分裂症患者的功能和组织，甚至可能危及药物治疗本身的持续进行。文中描述了药物对防御机制、客体关系、精神病性修复、外部现实的利用、身体意象和认知以及药物的象征意义所产生的影响。自恋性自我状态的改变和前意识过程的中断，叠加在有缺陷的自我功能之上，被用作解释性概念。这些与基于移情的反应相互作用；在某些情况下，会出现一些重要的心理动力学问题，适合进行移情解释。对内心变化的进一步研究，可能有助于描绘出以前无法解释的反应、理解症状形成、识别患者与心理治疗师关系的转变，以及防止过早停药。
