Catatonia induced by abrupt discontinuation of clozapine—case report

Abstract

Catatonia is characterized by a severe psychomotor change that, according to DSM-5, requires 3 or more of the following symptoms that is necessary to affirm its diagnosis: stupor, catalepsy, brain flexibility, mutism, negativism, posturing, mannerisms, stereotypes, agitation not influenced by external stimuli, grimaces, echolalia, or echopraxia. Clozapine is one of the second-generation antipsychotics that is recognized for its effectiveness in treating catatonia, rather than inducing it. However, its abrupt discontinuation can induce rapid clinical deterioration with multiple presentations including, psychoses or cholinergic rebound states, serotonergic syndromes, and catatonia.

Based on a clinical case, the authors intend to review the literature on catatonia associated with abrupt interruption of clozapine.

In this article, we present a case of a 34-year-old man, with a diagnosis of schizoaffective disorder, admitted to the psychiatric ward due to a psychotic decompensation, who developed a state of agitated catatonia secondary to the abrupt discontinuation of clozapine.

It is well established that the abrupt discontinuation of clozapine can trigger catatonia. This clinical case and literature review serves to emphasize the importance of educating psychiatrists on the adverse effects of psychiatric drugs and, in this case, the gradual and cautious discontinuation of clozapine in order to avoid its rebound effects.