Rebound psychosis following withdrawal of clozapine

Witharana, Dumindu; Basu, Amlan

doi:10.1192/pb.35.4.155

Cited by 3 publications

(2 citation statements)

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“…This includes the missed appointment, emergence of significant psychotic symptoms, and need for haloperidol. Numerous publications [4][5][6][7] note the concern of severe rebound psychosis with abrupt clozapine discontinuation and even dose reduction, and it is plausible that fluctuations of serum concentrations, as in this case, could produce similar effects.…”

Section: Discussionmentioning

confidence: 87%

Fluctuation between cigarette smoking and use of electronic nicotine delivery systems: Impact on clozapine concentrations and clinical effect

Montville

Lindsey

Leung³

2021

Mental Health Clinician

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Unlike with smoking cigarettes, electronic nicotine delivery systems do not cause CYP450 1A2 induction as there is a lack of combustion and polycyclic aromatic hydrocarbon production. Changing to the use of an electronic nicotine delivery system from cigarettes can result in the deinduction of CYP450 1A2 and the increase of certain medication serum concentrations, including clozapine. A case is reported in which the switch from smoking to an electronic nicotine delivery system resulted in increased clozapine serum concentration and constipation, necessitating pharmacologic management. The patient ultimately transitioned back to cigarettes, which resulted in the emergence of psychiatric symptoms. An evaluation of longitudinal serum concentrations and clinical correlation is provided. It is important that patients and health care professionals have knowledge not only about the impact of smoking cigarettes on clozapine metabolism, but also the effects of switching to or from an electronic nicotine delivery system.

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Section: Discussionmentioning

confidence: 87%

Fluctuation between cigarette smoking and use of electronic nicotine delivery systems: Impact on clozapine concentrations and clinical effect

Montville

Lindsey

Leung³

2021

Mental Health Clinician

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“…Previous research indicates that discontinuation of clozapine in patients with more chronic illness leads to increased polypharmacy, 20 increased hospital stay, 24 increased rates of relapse, 21,22 a reduction in quality of remission, 33 and increased frequency of acute withdrawalrelated phenomena including rebound and supersensitivity psychosis. 34,35 Conversely, there is very limited evidence suggesting that clinical status remains unaffected after discontinuation. 25 With regards to reasons for discontinuation in this study, non-compliance and adverse effects unrelated to neutropenia made up the majority of cases.…”

Section: Discussionmentioning

confidence: 99%

Clozapine discontinuation in early schizophrenia: a retrospective case note review of patients under an early intervention service

Shaker

Jones

2017

Therapeutic Advances in Psychopharmacology

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Aim:Research in patients with treatment-resistant schizophrenia has demonstrated that clozapine discontinuation is associated with poor outcomes. There is, however, a paucity of research investigating the impact of clozapine discontinuation specifically in younger patients with more recent onset schizophrenia. A case note review was therefore conducted to ascertain medium-term prognoses in patients with treatment-resistant schizophrenia under an early intervention service (EIS) following clozapine discontinuation.Methods:The case notes of 25 patients under the care of Birmingham EIS who discontinued clozapine were examined retrospectively. Reasons for discontinuation were recorded. Clinical outcomes including total duration of inpatient or home treatment admission, antipsychotic dose, number of alternative antipsychotics prescribed and adverse events were recorded for both the year before and the year after stopping clozapine. Statistical comparisons of pre- and post-discontinuation clinical outcomes determined whether discontinuation had negative effects.Results:There was no significant difference between the pre- and post-discontinuation clinical status following clozapine discontinuation. More than half (56%) of patients remained stable after stopping clozapine. Mean inpatient or home treatment stay rose from 29.7 to 62.6 days (p = 0.155), total antipsychotic dose from 50.1% of British National Formulary (BNF) limits to 60.5% (p = 0.627), number of alternative antipsychotics prescribed from 1.28 to 1.80 (p = 0.186), number of hospital/home treatment episodes from 0.20 to 0.44 (p = 0.083) and number of adverse events from 0 to 0.20 (p = 0.059). Non-compliance was the main reason for discontinuation (44%, n = 11).Conclusions:This is the first clozapine discontinuation study specifically considering EIS patients. Discontinuation did not lead to significant effects on 1 year outcomes, though the study is underpowered. These findings may be used to inform future prospective cohort discontinuation studies.

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