The Treatment of Clozapine-Withdrawal Delirium with Electroconvulsive Therapy

Modak, Anish; Åhlin, Anders

doi:10.1155/2017/1783545

Cited by 2 publications

(2 citation statements)

References 19 publications

(20 reference statements)

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“…Biperiden was chosen in our case because it is the only oral anticholinergic registered in Switzerland. If clozapine-withdrawal symptoms, namely catatonia, mania or rebound psychosis are resistant to progressive tapering or anticholinergic substitution, electroconvulsive therapy may be proposed according to some authors [29].…”

Section: Discussionmentioning

confidence: 99%

A case report of cholinergic rebound syndrome following abrupt low-dose clozapine discontinuation in a patient with type I bipolar affective disorder

et al. 2019

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Background Rebound cholinergic syndrome is a rare, but well known unwanted phenomenon occurring after abrupt clozapine discontinuation. There have been previous reported cases of cholinergic rebound in the literature; however, these reports described cholinergic rebound following cessation of high doses of clozapine in patients diagnosed with schizophrenia. Here, we report a case of rebound cholinergic syndrome and catatonia in a male patient three days after abrupt discontinuation of 50 mg of clozapine prescribed for type I bipolar affective disorder. Case presentation A 66-year old male of Spanish origin, treated for type I bipolar affective disorder for 15 years and for Crohn disease, was brought to the emergency department because of a sudden onset of mutism, dysphagia and trismus. He was described catatonic and presented hypertension, tachycardia and tachypnea. His body temperature was normal and the laboratory tests were unremarkable at presentation. A head CT and an EEG were in the normal range. While reviewing his history, it appeared the he was on clozapine 50 mg a day, first introduced 2 months ago, during a previous hospitalization for a manic episode resistant to other mood stabilizers. For an unknown reason, the patient’s psychiatrist stopped clozapine three days before the admission and replaced it by risperidone 5 mg and quetiapine 200 mg daily. A cholinergic rebound syndrome was then evoked. The patient’s ability to speak recovered dramatically and fast after the intravenous administration of 2.5 mg of biperiden supporting the diagnosis. Risperidone and quetiapine were also stopped. The patient fully recovered in 20 days after the reintroduction of 50 mg of clozapine and 2.5 mg of biperiden daily. Conclusions This case report underscores that cholinergic rebound syndrome may occur in patients suffering from bipolar affective disorders, being on clozapine as a mood stabilizer. The low dose clozapine does not preclude severe manifestations of the phenomenon. Progressive tapering should therefore be adopted in any case.

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Section: Discussionmentioning

confidence: 99%

A case report of cholinergic rebound syndrome following abrupt low-dose clozapine discontinuation in a patient with type I bipolar affective disorder

et al. 2019

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“…In addition, abrupt clozapine withdrawal increases the risk of relapse psychosis and catatonia 42,43,44 . Clozapine withdrawal delirium and psychosis 45 can easily be confused with that of COVID‐19 encephalitis and COVID‐19 related autoimmune limbic encephalitis, that include changes in consciousness level (easily confused with stupor in catatonia), altered mental state, seizures, headaches and weakness 46,47,48 . Cases of COVID‐19‐related catatonia have been described in non‐psychiatric patients 49,50,51 .…”

Section: Challenges Related To Clozapine and Covid‐19mentioning

confidence: 99%