Acute brain syndrome after tapering off clozapine in clozapine-lithium combination

1. This is a report of a patient who developed an acute organic psychosis due to neurotoxicity of lithium several days after tapering off a long-lasting clozapine therapy. 2. The organic brain syndrome with initial illusionary misperceptions, a confusional state and a lapse into a pre-coma developed three days after the end of clozapine therapy and seven days after the beginning of haloperidol addition. 3. Possible pharmacokinetic and pharmacodynamic factors responsible for the severe neurotoxicity of lithium after withdrawal of clozapine and addition of haloperidol are discussed.