Abstract
Clozapine is the mainstay of therapy for resistant schizophrenia. The compliance of medication in this patient group is poor. Instances of catatonia following abrupt discontinuation of clozapine have been reported. We report a case of a 44-year old woman who developed catatonia on two occasions following abrupt discontinuation of clozapine, and who improved after the reinstatement of clozapine. Although only rarely reported, clinicians should be aware of this phenomenon, in order to facilitate psycho-education, early recognition, avoid unnecessary investigations and minimize inadvertent delay of reinstatement of clozapine therapy DOI: http://dx.doi.org/ 10.4038/sljpsyc.v5i2.7820 Sri Lanka Journal of Psychiatry Vol 5(2):27-28
Highlights
Clozapine is the only atypical antipsychotic which is effective in alleviating both positive and negative symptoms in schizophrenia
In the medical ward she was investigated for meningitis and encephalitis but her blood and cerebrospinal fluid investigations, electroencephalogram (EEG) and computed tomography (CT) of brain did not reveal any abnormalities
Features of catatonia improved within 4 weeks but she remained functionally impaired with inability to attend to basic needs independently
Summary
Clozapine is the only atypical antipsychotic which is effective in alleviating both positive and negative symptoms in schizophrenia. A 44 year old woman with schizophrenia presented to a medical ward with a short history of total refusal of food, muteness, rigidity and alternating agitated and retarded behaviour She had been prescribed clozapine for the last 10 years and was functioning independently, until the death of her mother three months prior to the index presentation. She improved within a week and was discharged on 400 mg of clozapine daily She re-presented a month later with a similar clinical presentation characterized by muteness, negativism, double incontinence, refusal of food or fluid and behaviour that alternated between retardation and severe agitation. Features of catatonia improved within 4 weeks but she remained functionally impaired with inability to attend to basic needs independently She remained in the ward for three months and was discharged to a rehabilitation centre due to poor functional recovery and for monitoring of ongoing medication compliance
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