SEVERE WITHDRAWAL AKATHISIA FOLLOWING NEUROLEPTIC DISCONTINUATION SUCCESSFULLY CONTROLLED BY CLOZAPINE

Akathisia is one of the most distressing side effects of neuroleptic t reatment, It is usually managed by manipulating the neuroleptic dose a nd administering anti-akathisic compounds (beta-blockers, anticholiner gics, serotonin antagonists). However, the pathophysiological backgrou nd of withdrawal akathisia which follows the discontinuation of neurol eptic treatment remains unclear, and there is as yet no adequate treat ment. We report a case of severe withdrawal akathisia associated with suicidal and autoaggressive behaviour during a gradual transition from perphenazine/trihexyphenidyl to clozapine. The akathisia was effectiv ely managed by titration of clozapine (maximum dose 200 mg/day) Therea fter, reduction of the clozapine dose resulted in a recurrence of the akathisia, and the resumption of clozapine dose was accompanied by ful l amelioration of symptoms. We suggest that the antiserotonergic prope rties of clozapine were responsible for its anti-akathisic effect. Dif ferences in the treatment of acute and withdrawal types of akathisia a re emphasized.