Jk. Stanilla et al., CLOZAPINE WITHDRAWAL RESULTING IN DELIRIUM WITH PSYCHOSIS - A REPORT OF 3 CASES, The Journal of clinical psychiatry, 58(6), 1997, pp. 252-255
Background: Withdrawal symptoms for typical antipsychotics are general
ly mild, self-limited and do not include development of psychotic symp
toms. In contrast, withdrawal symptoms for clozapine can be severe wit
h rapid onset of agitation, abnormal movements, and psychotic symptoms
. Different pathophysiologic etiologies have been suggested for these
severe symptoms, including dopaminergic supersensitivity and rebound.
Method: Three case reports of clozapine withdrawal symptoms are presen
ted. A review of previous case reports and discussion of the etiology
of withdrawal symptoms of typical antipsychotics and clozapine are pro
vided. Results: These three patients developed delirium with psychotic
symptoms that resolved rapidly and completely upon resumption of low
doses of clozapine. Conclusion: The severe agitation and psychotic sym
ptoms after clozapine withdrawal in these three patients were due to d
elirium, perhaps the result of central cholinergic rebound. The withdr
awal symptoms and delirium resolved rapidly with resumption of low dos
es of clozapine. Severe withdrawal symptoms can probably be avoided by
slowly tapering clozapine and/or simultaneously substituting another
psychotropic with high anticholinergic activity, such as thioridazine.