Clozapine
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Withdrawal catatonia: case report A 46-year-old man exhibited withdrawal catatonia following withdrawal of clozapine. The man, who had residual schizophrenia for 30 years, had been receiving treatment with clozapine 200 mg/day for 10 years [route not stated]. Two months prior to admission, he stopped taking his pills. By day 5 of clozapine withdrawal, he refused oral intake, became uncommunicative and was unable to move and speak. He was admitted to a psychiatric hospital and was diagnosed with catatonic schizophrenia and received electroconvulsive therapy (ECT). However, his symptoms did not resolve after 11 sessions of ECT. Due to clinical deterioration and decubitus ulcers [aetiology unknown], he was transferred to a general medical hospital. Mental examination showed he was mute, cachectic and his only response to verbal stimulus was eye contact. He responded to questions by closing eyes. He showed reluctance to communicate and his affect was restricted. There was no rigidity noted. His Bush-Francis catatonia scale score was 13. An EEG did not reveal any abnormalities. He was found to have Pseudomonas aeruginosa infection [aetiology unknown]. The man had no oral intake. Hence, he required supportive treatment, including parenteral nutrition for the first 4 days, which was followed by nasogastric feeding. On day 2 of admission, clozapine 100 mg/day was re-administered. Two days later, he started responding to questions with one word replies. He experienced sleeplessness [aetiology unknown], and lorazepam was added to his regimen on day 4. By day 6, he could get out of bed and take a few steps with support. By the end of the first week, he was able to answer questions with a few words. His nasogastric feeding was discontinued, and he started taking nutrition orally. He could walk without support. He had persecutory delusions and visual and auditory hallucinations (symptoms of underlying schizophrenia). Thus, the dose of clozapine was increased gradually to 200 mg/day at day 7 and to 250 mg/day at day 21. After the twentieth day of admission, his medical condition showed significant improvement, and he was able to eat and drink. His delusions and hallucinations resolved (symptoms of underlying schizophrenia). Improvement in social cohesion was noted. He was discharged from hospital after 30 days. Thus, based on the appearance of catatonic symptoms after clozapine withdrawal and their recovery after clozapine re-admission, a diagnosis of clozapine withdrawal catatonia was made. Author comment: "In this case, the fact that catatonia occured soon after discontinuing clozapine and recovered dramatically after clozapine resumption indicates that it was related to the withdrawal of clozapine." Cerit C, et al. Clozapine withdrawal catatonia refractory to ECT: A case report. Klinik Psikofarmakoloji Bulteni 22: 275-277, No. 3, 2012. Available from: URL: 803443830 http://doi.org/10.5455/bcp.20120731051540 - Turkey
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