CLOZAPINE WITHDRAWAL RESULTING IN DELIRIUM WITH PSYCHOSIS - A REPORT OF 3 CASES

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.