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Clozapine Withdrawal Catatonia: A Case Report
Amit Jagtiani1, Tarika Nagi2,3, Raghu Gandhi4
1Psychiatry, Burrell Behavioral Health, Springfield, USA.
Cureus
|February 19, 2024
Summary
Abrupt clozapine discontinuation can trigger catatonia, a serious condition linked to GABA hypoactivity. Prompt benzodiazepine treatment, like lorazepam, can effectively manage these symptoms, facilitating clozapine re-initiation.
Area of Science:
- Neuroscience
- Psychiatry
Background:
- Catatonia is linked to gamma-aminobutyric acid (GABA) hypoactivity and often responds to benzodiazepines.
- Clozapine, an antipsychotic for treatment-resistant schizophrenia, can precipitate catatonia upon abrupt discontinuation.
Observation:
- A 66-year-old male with schizoaffective disorder developed catatonia 7 days after abruptly stopping clozapine due to unavailability.
- Initial presentation included self-neglect, auditory hallucinations, psychomotor retardation, and thought blocking, which were initially unrecognized.
Findings:
- Attempts to reintroduce clozapine caused orthostatic hypotension, and risperidone worsened catatonic symptoms.
- Intravenous lorazepam administration rapidly resolved the catatonia, enabling a slow re-titration of clozapine.
Implications:
- This case highlights the risk of catatonia following abrupt clozapine cessation.
- Benzodiazepine administration is a crucial intervention for managing clozapine-discontinuation-induced catatonia.
- Careful clozapine management and monitoring are essential to prevent severe adverse psychiatric outcomes.
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