Abrupt Discontinuation Of Clozapine Research Articles

Catatonia induced by abrupt discontinuation of clozapine - case report

IntroductionCatatonia is characterized by a bizarre and severe psychomotor change. According to DSM-5, the presence of three or more symptoms is necessary to affirm the diagnosis: stupor, catalepsy, brain flexibility, mutism, negativism, posturing, mannerisms, stereotypes, agitation not influenced by external stimuli, grimaces, echolalia or echopraxia. The association between first- and second-generation antipsychotics (AP) and the onset of catatonia is well established in the literature. In contrast, clozapine is one of the second-generation APs that is recognized for its effectiveness in treating catatonia, rather than inducing it. However, it has been documented that abrupt discontinuation of clozapine can induce rapid clinical deterioration with multiple presentations including: psychoses, cholinergic rebound states, serotonergic syndromes and catatonia.ObjectivesReview the literature on catatonia associated with abrupt interruption of clozapine. Describe a clinical case.MethodsObservation of the patient and consultation the clinical file. Non-systematic literature review on catatonia, clozapine, side effects associated with rapid discontinuation and respective treatment.Results34-year-old man, with the diagnosis of Schizoaffective Disorder. Admitted due to an acute decompensation with psychotic symptoms resistant to treatment requiring the introduction of clozapine. In the absence of a clinical response, clozapine was suspended, with the consequent appearance of catatonia resistant to benzodiazepines in high doses.ConclusionsIts already well established that the abrupt discontinuation of clozapine can trigger catatonia. This clinical case and literature review suits to emphasize the importance of educating psychiatrists on the adverse effects of psychiatric drugs and, in this case, the cautious discontinuation of clozapine in order to avoid its rebound effects.

Rapid-Onset Psychosis and Cholinergic Rebound After Abrupt Discontinuation of Clozapine

Rapid-Onset Psychosis and Cholinergic Rebound After Abrupt Discontinuation of Clozapine

Une catatonie réversible suite à l’arrêt brutal de la clozapine. À propos d’un cas

In this paper, we report the case of a patient, aged 26, with schizophrenia who was admitted to psychiatric emergencies for catatonia, one week after abrupt discontinuation of clozapine. An improvement was seen after only two days of the reintroduction of clozapine alone. This catatonia is reversible and it responds magnificently to the reintroduction of clozapine. And we conclude that patients and their caregivers need to be educated about the effects of abrupt cessation of clozapine administration.

Catatonia following abrupt discontinuation of clozapine

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

Psychotropic discontinuation leading to an NMS‐like condition

AbstractNeuroleptic malignant syndrome (NMS) is a potentially life‐threatening condition, which can occur as a complication in patients taking antipsychotic medications. Drs Kurien and Vattakatuchery present the case of a patient with paranoid schizophrenia who developed NMS‐like symptoms following abrupt discontinuation of clozapine and venlafaxine.

Catatonic Dilemma in a 33-Year-Old Woman: A Discussion

Case. We report a case of catatonia with elevated CK, elevated temperature, and hypoferritinemia after abrupt discontinuation of clozapine in a patient with known proneness to catatonic symptoms. Reinstatement of clozapine therapy was contraindicated due to leukopenia. Neuroleptic malign syndrome could not be ruled out by the administration of quetiapine; this prevented the quick use of other potent D2 antagonists. Some improvement was achieved through supportive therapy, high dose of lorazepam, and a series of 10 ECT sessions. Returning to baseline condition was achieved by a very careful increase of olanzapine. Discussion. Catatonic symptoms in schizophrenia as well as in NMS might be caused by a lack of striatal dopamine (CS) or dopamine D2 antagonism (NMS). CS might be a “special” kind of schizophrenia featuring both hypo- and hyperactivity of dopaminergic transmission. ECT has been described as a “psychic rectifier” or a “reset for the system.” The desirable effect of ECT in cases of CS might be dopaminergic stimulation in the striatum and decrease of both the dopaminergic activity in the limbic system and the serotonergic activity on 5-HT2 receptors. The desirable effect of ECT in NMS would be explained by activation of dopaminergic transmission and/or liberation of dopaminergic receptors from the causative neuroleptics.

Neuroleptic malignant syndrome and clozapine withdrawal at the same time?

The authors report a case of a patient, who in a few days after an abrupt discontinuation of clozapine and haloperidol developed agitated and confused state resembling neuroleptic malignant syndrome (NMS) and clozapine withdrawal symptoms at the same time. Data obtained from family members led to gradual reintroduction of clozapine and to subsequent recovery. The case illustrates the importance for clinicians to be familiar with the variety of discontinuation symptoms, so they can recognize them and offer effective treatment.

Clozapine Withdrawal Catatonia Associated With Cholinergic and Serotonergic Rebound Hyperactivity

Catatonia as a clozapine withdrawal syndrome has not been well documented. There is only 1 case of excited catatonia described with the diagnosis made according to strict criteria. The authors report a patient who developed a catatonic stuporous state following abrupt discontinuation of clozapine, associated with features of cholinergic and serotonergic hyperactivity. The catatonic state resolved within 1 week with reinstatement of clozapine. It is suggested that serotonergic hyperactivity was involved, contributed by cholinergic rebound, in the pathogenesis of this patient's clozapine withdrawal catatonic syndrome.