clozapine and Catatonia

Clozapine is a potent antipsychotic medication with a complex receptor profile. It is reserved for treatment-resistant schizophrenia. We systematically reviewed studies of non-psychosis symptoms of clozapine withdrawal.. CINAHL, Medline, PsycINFO, PubMed, and the Cochrane Database of Systematic Reviews were searched using the keywords 'clozapine,' and 'withdrawal,' or 'supersensitivity,' 'cessation,' 'rebound,' or 'discontinuation'. Studies related to non-psychosis symptoms after clozapine withdrawal were included.. Five original studies and 63 case reports / series were included in analysis. In 195 patients included in the five original studies, approximately 20% experienced non-psychosis symptoms following discontinuation of clozapine. In 89 patients in four of the studies, 27 experienced cholinergic rebound, 13 exhibited extrapyramidal symptoms (including tardive dyskinesia), and three had catatonia. In 63 case reports / series included, 72 patients with non-psychosis symptoms were reported, which were catatonia (n=30), dystonia or dyskinesia (n=17), cholinergic rebound (n=11), serotonin syndrome (n=4), mania (n=3), insomnia (n=3), neuroleptic malignant syndrome (NMS) [n=3, one of them had both catatonia and NMS], and de novo obsessive compulsive symptoms (n=2). Restarting clozapine appeared to be the most effective treatment.. Non-psychosis symptoms following clozapine withdrawal have important clinical implications. Clinicians should be aware of the possible presentations of symptoms to ensure early recognition and management. Further research is warranted to better characterise the prevalence, risk factors, prognosis, and optimal drug dosing for each withdrawal symptom.

Topics: Antipsychotic Agents; Catatonia; Cholinergic Agents; Clozapine; Humans; Schizophrenia; Substance Withdrawal Syndrome

Withdrawal symptoms are common upon discontinuation of psychiatric medications. Catatonia, a neuropsychiatric condition proposed to be associated with gamma-aminobutyric acid (GABA) hypoactivity due to its robust response to benzodiazepines, has been described as a withdrawal syndrome in case reports but is not a well-recognized phenomenon. The authors undertook a review of withdrawal catatonia with an aim to understand its presentation as well as the medications and psychoactive substances it is associated with. The review identified 55 cases of withdrawal catatonia, the majority of which occurred upon discontinuation of benzodiazepines (24 cases) and discontinuation of clozapine (20 cases). No other antipsychotic medications were identified as having been associated with the onset of a catatonic episode within 2 weeks following their discontinuation. Increasing GABA activity and resultant GABA receptor adaptations with prolonged use is postulated as a shared pharmacological mechanism between clozapine and benzodiazepines that underlie their association with withdrawal catatonia. The existing evidence for clozapine's activity on the GABA system is reviewed. The clinical presentations of benzodiazepine withdrawal catatonia and clozapine withdrawal catatonia appear to differ and reasons for this are explored. One reason is that benzodiazepines act directly on GABA

Topics: Benzodiazepines; Catatonia; Clozapine; GABA Antagonists; Humans; Substance Withdrawal Syndrome

The existence of a focal brain lesion that might be the crucial cause for the development of diverse psychiatric phenomena and certain characteristics of personality is often a controversial issue. The patient was a 29-year-old male when he killed his father with a single knock with the blunt side of an axe. Subsequently to the act, the patient developed a 10-month-long catatonic stupor during which he experienced intensive fear, delusions, and affective symptoms. He was an emotionally blunted person with no medical record and without prior history of aggressive behavior. Magnetic resonance image revealed a large, right-sided arachnoid cyst that was associated with right temporal and frontal lobe hypoplasia and bilateral changes of perfusion in peri-insular regions. The treatment with clozapine and diazepam showed to be therapeutic. This could be the second case of homicide committed by a person with arachnoid cyst and without past history of aggression, and the second description of an adult patient with cyst who developed catatonic stupor. This is the first description of long-lasting organic catatonic stupor treated with clozapine and diazepam. Relevant literature is reviewed and some controversial issues are discussed.

Topics: Adult; Antipsychotic Agents; Arachnoid Cysts; Catatonia; Clozapine; Delusions; Diazepam; Homicide; Humans; Male

Despite the fact that many studies have addressed the use of ECT in schizophrenia questions on clinical use remain poorly answered and clinical application is largely based on data originating from depressed patients.. We review data on the use of ECT in schizophrenic patients drawn from original studies indicated by a Pubmed search and referenced in recent and older expert reviews with a specific focus on four issues: symptom response, technical application, continuation/maintenance ECT and combination with medication.. Catatonic patients are the most responsive. Positive symptoms such paranoid delusions and affective symptoms follow. There are indications that ECT may improve responsivity to medication. No particular technical features stand out in studies except lengthier courses, but not for catatonia. Combination with medication appears to be preferable over either treatment alone and effective combination particularly with clozapine is supported by data. Use of continuation and maintenance treatments in responders appears beneficial.. Certain schizophrenic patients may benefit significantly from the use of ECT. More specific research is required to address particular questions.

Topics: Antipsychotic Agents; Catatonia; Clozapine; Combined Modality Therapy; Electroconvulsive Therapy; Humans; Schizophrenia

An increasing number of reports suggest a link between venous thromboembolism (VTE) and the use of antipsychotics. To better understand this association the available body of evidence has been critically scrutinised. Relevant articles were identified in the databases Scopus and PubMed. Several observational studies using different methodologies show an increased risk of VTE in psychiatric patients. This elevated risk seems to be related to the use of antipsychotic medication and in particular to the use of clozapine and low-potency first-generation drugs. Many studies investigating the association have, however, methodological limitations. The biological mechanisms involved in the pathogenesis of this possible adverse reaction are largely unknown but several hypotheses have been suggested such as drug-induced sedation, obesity, increased levels of antiphospholipid antibodies, enhanced platelet aggregation, hyperhomocysteinemia and hyperprolactinemia. The association may also be related to underlying risk factors present in psychotic patients. Physicians need to be aware of this possible adverse drug reaction. Although supporting evidence has not been published they should consider discontinuing or switching the antipsychotic treatment in patients experiencing VTE. In addition, although data is lacking, the threshold for considering prophylactic antithrombotic treatment should be low when risk situations for VTE arise, such as immobilisation, surgery and so on.

Topics: Adolescent; Adult; Aged; Antipsychotic Agents; Case-Control Studies; Catatonia; Clozapine; Death, Sudden; Dehydration; Female; Humans; Male; Middle Aged; Models, Biological; Platelet Aggregation; Pulmonary Embolism; Restraint, Physical; Retrospective Studies; Risk; Risk Factors; Thrombophilia; Venous Thromboembolism; Young Adult

Malignant catatonia, associated with different somatic and psychiatric disorders, is a rare, life-threatening syndrome. Immediate recognition and adequate treatment are essential and may be life-saving. We describe a case of malignant catatonia and discuss the clinical implications. Additionally, we review the recent literature regarding epidemiology, nosology, current pathophysiological concepts, differential diagnosis, and treatment recommendations.

Topics: Adult; Biperiden; Catatonia; Clopenthixol; Clozapine; Diagnosis, Differential; Diazepam; Drug Administration Schedule; Drug Therapy, Combination; Humans; Injections, Intramuscular; Male; Schizophrenia, Disorganized

Topics: Antipsychotic Agents; Benzodiazepines; Cardiomyopathies; Catatonia; Clozapine; Heart Failure; Humans; Olanzapine; Rhabdomyolysis

Topics: Antipsychotic Agents; Antisocial Personality Disorder; Catatonia; Clozapine; Humans; Schizophrenia

Topics: Antipsychotic Agents; Catatonia; Clozapine; Humans; Psychotic Disorders; Quetiapine Fumarate

Catatonia is a severe clinical syndrome which has been increasingly reported in autism spectrum disorder (ASD). The prevalence of catatonia in ASD is unknown. Diagnosing catatonia in ASD is complicated by overlapping clinical features such as mutism, stereotypies, and echophenomena. Here, we present the clinical histories of two individuals with ASD and catatonia who were successfully treated with clozapine. We have reported on a novel potential treatment option for catatonia in ASD. Additional studies are needed to evaluate the safety, efficacy, and tolerability of clozapine for the treatment of catatonia in ASD.

Topics: Autism Spectrum Disorder; Catatonia; Clozapine; Humans; Stereotyped Behavior; Stereotypic Movement Disorder

Topics: Antipsychotic Agents; Catatonia; Clozapine; gamma-Aminobutyric Acid; Humans; Receptors, GABA-B

Topics: Antipsychotic Agents; Antisocial Personality Disorder; Catatonia; Clozapine; Humans; Male; Schizophrenia; Substance Withdrawal Syndrome

Topics: Antipsychotic Agents; Catatonia; Clozapine; Electroconvulsive Therapy; Humans

Topics: Antipsychotic Agents; Catatonia; Clozapine; Humans; Intensive Care Units; Schizophrenia; Substance Withdrawal Syndrome

We report four cases of 12- to 17-year-old patients with schizophrenia, two of them suffering from catatonia, which were treated by ECT. Under a combined treatment with either ziprasidone or clozapine, and electroconvulsive therapy (ECT), they improved markedly. Severity and course of acute schizophrenia were evaluated by the Brief Psychiatric rating Scale (BPRS), severity and course of catatonia were evaluated with the Bush-Francis Catatonia Rating Scale (BFCRS). This article underlines the benefit, the safety and the tolerability of ECT in younger patients with schizophrenic disorders.. Wir berichten über vier Patienten im Alter von 12 bis 17 Jahren mit schizophrenen Psychosen, zwei davon mit katatoner Symptomatik, die erfolgreich und sicher mit Elektrokonvulsionstherapie (EKT) behandelt wurden. Unter einer kombinierten Therapie aus EKT und entweder Ziprasidon oder Clozapin verbesserte sich der Zustand aller Patienten erheblich. Schweregrad und Verlauf der akuten Schizophrenie wurden mit der Brief Psychiatric Rating Scale (BPRS) evaluiert. Schweregrad und Verlauf der Katatonie wurden mit der Bush-Francis Catatonia Rating Scale (BFCRS) gemessen. Die Fälle bestätigen frühere Berichte zur Wirksamkeit, zur Sicherheit und Verträglichkeit von EKT bei der Behandlung von Kindern und Jugendlichen mit Schizophrenie.

Topics: Adolescent; Catatonia; Child; Clozapine; Combined Modality Therapy; Electroconvulsive Therapy; Humans; Piperazines; Schizophrenia; Thiazoles; Treatment Outcome

Aim\ To describe an uncommon side effect of sudden withdrawal of Clozapine.\ Method\ This case describes the occurrence of catatonia following the sudden discontinuation of long term Clozapine therapy.\ Results\ Symptoms resolved with treatment with benzodiazepines and IV fluids.\ Discussion\ In conclusion, catatonia can occur on sudden discontinuation of Clozapine therapy. Caution should be exercised when reducing or discontinuing this medication.

Topics: Antipsychotic Agents; Catatonia; Clozapine; Humans; Male; Middle Aged; Schizophrenia; Substance Withdrawal Syndrome

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.. 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.. 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.

Topics: Aged; Antipsychotic Agents; Bipolar Disorder; Catatonia; Cholinergic Agents; Clozapine; Humans; Male; Substance Withdrawal Syndrome; Withholding Treatment

Topics: Antipsychotic Agents; Benzodiazepines; Catatonia; Clozapine; GABAergic Neurons; gamma-Aminobutyric Acid; Humans; Synaptic Transmission

Patients with psychiatric disorders in critical condition are difficult to treat. In this study, we report on a patient with underlying schizoaffective disorder who developed catatonia, cardiac arrest, and pulmonary embolism, as well as a successful treatment strategy.. The inpatient is a 41-year-old morbidly obese male with schizoaffective disorder whose clozapine dosage was titrated from 100 mg to 175 mg due to auditory hallucination and agitation. The patient abruptly developed acute cardiopulmonary symptoms associated with an elevated troponin-I level. He was transferred to a cardiac intensive care unit, where he remained for 3 days. He was also found to have excited catatonic symptoms, and the lorazepam-diazepam protocol was initiated to quickly relieve the catatonia. Once the coronary angiogram was read as normal, the patient was transferred back to the psychiatric ward. However, the patient then suffered from in-hospital cardiac arrest. He was resuscitated and again transferred to the medical intensive care unit. Computed tomography confirmed the diagnosis of a pulmonary embolism. The patient was treated with Rivaroxaban 30 mg/d for the first 21 days, followed by 20 mg daily for 3 months. To control his severe and refractory psychotic symptoms, the patient was re-prescribed clozapine. During the 15-month follow-up period, the patient demonstrated a fair response and tolerability to clozapine 150 mg without symptoms relapse and no thromboembolic event.. This report can serve to remind psychiatrists and physicians to be aware of fatal conditions in patients with psychiatric diseases and physical illnesses.

Topics: Adult; Antipsychotic Agents; Catatonia; Clozapine; Drug Therapy, Combination; Factor Xa Inhibitors; Hallucinations; Humans; Male; Obesity, Morbid; Psychotic Disorders; Pulmonary Embolism; Rivaroxaban; Treatment Outcome

Topics: Adolescent; Antipsychotic Agents; Catatonia; Clozapine; Delusions; Feeding and Eating Disorders of Childhood; Haiti; Humans; Male; Marijuana Abuse; Olanzapine; Schizophrenia; Weight Loss

Topics: Adult; Antipsychotic Agents; Catatonia; Clozapine; Diagnosis, Differential; Humans; Male; Neuroleptic Malignant Syndrome; Psychoses, Substance-Induced; Schizophrenia; Substance Withdrawal Syndrome

Periodic catatonia has long been a challenging diagnosis and there are no absolute guidelines for treatment when precipitating factors are also unclear. We report a schizophrenia patient with periodic catatonia with a 15-year treatment course. A possible correlation between decreased daylight exposure and periodic attacks has been observed.. We describe a 49-year-old woman with periodic catatonia associated with schizophrenia with 15 years of follow-up. The patient was treated with the antipsychotics risperidone, haloperidol, loxapine and quetiapine, but catatonia still relapsed once per year during the first few years of her disease course. The treatment was consequently been switched to clozapine due to fluctuated psychotic illness, and a longer duration of remittance was achieved. Lorazepam-diazepam protocol was used for rapid relief of catatonic symptoms, and was able to significantly shorten the duration of the symptoms. In addition, we observed a possible correlation between catatonic episodes and decreased daylight exposure during the 15-year duration.. Successful treatment of acute periodic catatonia was achieved with a lorazepam-diazepam protocol, and the patient remained in remission for a longer duration under clozapine treatment. Besides, the possibility of decreased daylight exposure acting as a precipitating factor was observed during our 15 years of follow-up.

Topics: Antipsychotic Agents; Catatonia; Clozapine; Drug Therapy, Combination; Female; Haloperidol; Humans; Loxapine; Middle Aged; Risperidone; Schizophrenia

Topics: Adult; Antipsychotic Agents; Catatonia; Clozapine; Humans; Male; Neuroleptic Malignant Syndrome

Relieving catatonia helps identify the underlying etiology and its treatment. However, catatonia may reemerge after some time, but there are few data on the relapses and recurrences of catatonia. We aimed to investigate the characteristics of patients with relapses or recurrences of catatonia as well as the efficacy of the lorazepam-diazepam protocol on them.. Patients with catatonia who had more than one episode of catatonia and were treated with the lorazepam-diazepam protocol were identified. Their medical charts were reviewed, and interview was conducted.. Thirty patients were identified. Nineteen (63.3%) were diagnosed with schizophrenia, five (16.7%) with major depressive disorder, two (6.7%) with bipolar disorder, and four (13.3%) with general medical conditions. In the 68 relapses and relapses the lorazepam-diazepam protocol was used, full response was reported in 54 (79.4%) of them. Twelve of 19 (63.2%) patients with schizophrenia were treated with clozapine. Twenty (66.7%) out of 30 patients were maintained on oral lorazepam by the time of discharge. Literature review showed similar prevalence of schizophrenia in patients with more than one episode of catatonia, and a wide variety of treatment options.. The lorazepam-diazepam protocol was mostly effective in managing relapses and recurrences of catatonia. Maintenance clozapine and oral lorazepam were beneficial in a significant number of patients.

Topics: Adolescent; Adult; Antipsychotic Agents; Bipolar Disorder; Catatonia; Clozapine; Depressive Disorder, Major; Diazepam; Drug Therapy, Combination; Female; Humans; Hypnotics and Sedatives; Lorazepam; Male; Middle Aged; Recurrence; Schizophrenia, Catatonic; Young Adult

Topics: Antipsychotic Agents; C-Reactive Protein; Catatonia; Clozapine; Creatine Kinase; Dantrolene; Drug Monitoring; Drug Substitution; Echocardiography; Humans; Lorazepam; Male; Myocarditis; Neuromuscular Agents; Psychotic Disorders; Treatment Outcome; Troponin; Withholding Treatment; Young Adult

In this paper, we report the case of a patient, aged 26, with schizophrenia who was admitted to psychiatric emergencies for catatonia, one week after abrupt discontinuation of clozapine. An improvement was seen after only two days of the reintroduction of clozapine alone. This catatonia is reversible and it responds magnificently to the reintroduction of clozapine. And we conclude that patients and their caregivers need to be educated about the effects of abrupt cessation of clozapine administration.

Topics: Adult; Antipsychotic Agents; Catatonia; Clozapine; Humans; Male; Schizophrenia; Substance Withdrawal Syndrome; Treatment Outcome

Topics: Adult; Antipsychotic Agents; Catatonia; Clozapine; Diagnosis, Differential; Humans; Male; Schizophrenia

Topics: Adolescent; Amantadine; Anticonvulsants; Antiparkinson Agents; Antipsychotic Agents; Atrophy; Catatonia; Cerebral Cortex; Clozapine; Drug Therapy, Combination; Humans; Magnetic Resonance Imaging; Male; Memantine; Schizophrenia; Valproic Acid

Neuroleptic malignant syndrome (NMS) is a rare life-threatening condition associated with the use of antipsychotics and other drugs that influence dopaminergic transmission. Although NMS is typically associated with classical antipsychotics, it can also be induced by atypical antipsychotics. In this paper, we report a case of NMS associated with clozapine use.. A 27-year-old male was diagnosed as schizophrenia in 2006 and zuclopenthixol depot was administered parenterally. Following the second injection, NMS was diagnosed and he was switched to clozapine. After 4 years of clozapine use, one day, he suddenly stopped eating, stayed in bed all day, and had incontinence. Upon examination at our hospital the patient had muscle rigidity, high fever, leukocytosis, and a high creatine phosphokinase level, and NMS was diagnosed. He was put on bromocriptine. NMS resolved, but psychotic relapse and catatonia developed. 10 sessions of electro convulsive treatment (ECT) were administered. Quetiapine 25 mg/day was introduced and titrated up to 600 mg/day afterwards. He has been using quetiapine 600 mg/day for 18 months and at the time this manuscript was written has not had any signs of psychosis or NMS.. NMS is usually induced by the use of agents with high dopaminergic affinity. Incomplete or extraordinary NMS cases have been reported due to clozapine and atypical antipsychotics. The presented case is noteworthy due to the complete and typical presentation of NMS. It should always be kept in mind that all atypical antipsychotics including clozapine have the probability to induce NMS although not common.

Topics: Adult; Antipsychotic Agents; Catatonia; Clozapine; Creatine Kinase; Diagnosis, Differential; Humans; Male; Neuroleptic Malignant Syndrome; Psychotic Disorders; Quetiapine Fumarate; Schizophrenia; Serotonin Antagonists

Topics: Adult; Antipsychotic Agents; Catatonia; Clozapine; Disease Management; Female; GABA Modulators; Humans; Lorazepam; Remission Induction; Schizophrenia; Substance Withdrawal Syndrome; Treatment Outcome; Withholding Treatment

Topics: Adult; Antipsychotic Agents; Catatonia; Clozapine; Humans; Male; Schizophrenia; Substance Withdrawal Syndrome

Topics: Antipsychotic Agents; Catatonia; Clozapine; Delusions; Electroconvulsive Therapy; Female; Fever; Hallucinations; Humans; Recurrence; Young Adult

The case of a schizoaffective patient suffering from a malignant catatonic syndrome following combined lithium-risperidone therapy is explored.. A case report and relevant deliberations regarding pathophysiology of the catatonic dilemma are discussed.. There are two critical transitions in the development of a malignant catatonic syndrome. Dopaminergic system and psychopharmacological factors are supposed to play a key role. However, other neurotransmitter systems and the individual predisposition must be considered.

Topics: Antimanic Agents; Antipsychotic Agents; Brain; Catatonia; Clozapine; Diagnosis, Differential; Dopamine; Dose-Response Relationship, Drug; Drug Interactions; Drug Therapy, Combination; Electroencephalography; Humans; Hypnotics and Sedatives; Lithium Carbonate; Long-Term Care; Lorazepam; Male; Middle Aged; Psychotic Disorders; Risperidone; Serotonin

Topics: Catatonia; Clozapine; Family Health; Genetic Predisposition to Disease; Humans; Male; Middle Aged; Parkinson Disease; Psychotic Disorders; Substance Withdrawal Syndrome

Topics: Antipsychotic Agents; Catatonia; Clozapine; Electroconvulsive Therapy; Female; Humans; Long-Term Care; Medication Adherence; Middle Aged; Psychotic Disorders; Substance Withdrawal Syndrome

Catatonia is characterized by the predominance of psychomotor abnormalities and shares many clinical, biological and treatment response features with the neuroleptic malignant syndrome (NMS), a rare adverse reaction to psychoactive medications. It has been advocated that the two conditions should be placed along the same spectrum of disorders. A case of a 49-year-old woman, who developed NMS while on low dose clozapine soon after recovering from catatonia, is presented. The potential relationship between catatonia and NMS is discussed in the light of the existing literature, and attention is drawn to the risk for clozapine-induced NMS in catatonic patients.

Topics: Antipsychotic Agents; Catatonia; Clozapine; Dose-Response Relationship, Drug; Female; Humans; Middle Aged; Neuroleptic Malignant Syndrome; Psychotic Disorders; Risk Factors; Schizophrenia, Catatonic

Topics: Antipsychotic Agents; Catatonia; Clozapine; Humans; Neuroleptic Malignant Syndrome; Risperidone

Prolonged catatonia can be a source of extremely serious morbidity and mortality. Lorazepam is effective in rapidly relieving most cases of catatonia. Reports have also shown that second-generation antipsychotic drugs are also efficacious in relieving catatonia. This report describes two schizophrenia patients who demonstrated recurrent catatonic features mutism and stupor. Both patients were treated with lorazepam, diazepam or electroconvulsive therapy (ECT). Patient 1 responded well and rapidly to lorazepam each time catatonia happened; but catatonia recurred once a year under treatment with many antipsychotic drugs. Patient 2 had catatonia features associated with discontinuing or decreasing clozapine. With each recurrent episode, the duration of catatonia increased, requiring an increased dosage of benzodiazepine. The patient's response to lorazepam and ECT gradually decreased, until the patient had almost no response to lorazepam, diazepam or ECT. Both patients had no recurrence during a period of 2-year follow up with continuous clozapine therapy.

Topics: Adult; Antipsychotic Agents; Catatonia; Clozapine; Female; Humans; Recurrence; Schizophrenia; Treatment Outcome

Topics: Adult; Anti-Inflammatory Agents; Antipsychotic Agents; Brain; Catatonia; Clozapine; Encephalomyelitis, Acute Disseminated; Female; Humans; Magnetic Resonance Imaging; Methylprednisolone; Oligoclonal Bands; Temporal Lobe

Topics: Adult; Antipsychotic Agents; Catatonia; Clozapine; Female; Humans; Male; Middle Aged; Schizophrenia, Catatonic; Schizophrenic Psychology

Serious adverse events and even sudden death have been reported during administration of the combination of clozapine and benzodiazepines. However, this combination does not necessarily result in increased frequency of serious adverse events. Thus it is not regarded as an absolute contraindication and might be useful in distinct clinical situations, e.g., during the occurrence of a malignant neuroleptic syndrome, "catatonic dilemma," or severe agitation during clozapine treatment. In the following report, certain suggestions on how to deal with this combination therapy are provided which may provide a basis for discussion that ultimately may lead to the formulation of guidelines for this combination therapy. Such guidelines may help psychiatrists in dealing with this combination in clinical situations. Moreover, the formulation of such guidelines would help with forensic issues in case of serious adverse events occurring during this combination therapy.

Topics: Adverse Drug Reaction Reporting Systems; Anti-Anxiety Agents; Antipsychotic Agents; Benzodiazepines; Catatonia; Clozapine; Death, Sudden; Dose-Response Relationship, Drug; Drug Interactions; Drug Therapy, Combination; Humans; Neuroleptic Malignant Syndrome; Practice Guidelines as Topic; Risk Factors

Topics: Adolescent; Catatonia; Clozapine; Humans; Juvenile Delinquency; Lithium; Lorazepam; Male; Prisoners; Treatment Outcome

Topics: Acute Disease; Adolescent; Catatonia; Clozapine; Humans; Male; N-Methyl-3,4-methylenedioxyamphetamine

Topics: Adult; Antipsychotic Agents; Catatonia; Clozapine; Female; Humans

Topics: Antipsychotic Agents; Catatonia; Clozapine; Humans; Neuroleptic Malignant Syndrome; Receptors, Dopamine D2; Risk Factors

This report describes the case of a 61-year-old female schizophrenic patient with status post-frontal lobotomy some 35 years ago with prominent paranoid delusions. This woman developed severe catatonia under medication with a serotonergic/dopaminergic neuroleptic, risperidone, at a dose of up to 5 mg daily. The catatonic disorder was dose-dependent and subsided immediately after switching the medication to another atypical antipsychotic, clozapine. Given the negative history for catatonia in this patient, the temporal coincidence of administration of risperidone and catatonia is a novel finding.

Topics: Antipsychotic Agents; Catatonia; Clozapine; Delusions; Dose-Response Relationship, Drug; Female; Humans; Middle Aged; Risperidone; Schizophrenia, Paranoid; Treatment Refusal

Topics: Antipsychotic Agents; Brain Injuries; Catatonia; Clozapine; Female; Frontal Lobe; Humans; Middle Aged

Catatonia as a clozapine withdrawal syndrome has not been documented. We report a case of excited catatonia with fever, autonomic instability, and delirium--a picture of malignant catatonia (lethal catatonia) after abrupt clozapine withdrawal. The use of conventional neuroleptics transformed the excited malignant catatonia into a stuporous state resembling neuroleptic malignant syndrome (NMS). Such a transformation of excited lethal catatonia into NMS has been described in the literature, providing support for the hypothesis that NMS is a variant of catatonia. Opinions, however, have been conflicting whether lethal catatonia and NMS are indistinguishable. We argue that NMS may be regarded as a neuroleptic-induced retarded (stuporous) subtype of malignant catatonia, clinically indistinguishable from nonneuroleptic retarded malignant catatonia but different from the excited form. To differentiate between the two subtypes of malignant catatonia would help resolve the controversy. The nosological status of excited catatonia, a poorly studied condition, remains unclear. The two subtypes of catatonia may differ in pathophysiology and responses to treatment. Clinicians should be alert to catatonia as a possible clozapine withdrawal phenomenon, and excited catatonia deserves more research attention.

Topics: Adult; Antipsychotic Agents; Catatonia; Clozapine; Humans; Male; Neuroleptic Malignant Syndrome; Schizophrenia; Substance Withdrawal Syndrome

A haloperidol-treated patient with chronic schizophrenia had a near-arrhythmic circadian rest-activity cycle, whereas rhythms of 6-sulphatoxy-melatonin and core body temperature were of normal amplitude and phase-advanced. Sleep electroencephalography measured throughout a 31-h 'constant-bedrest' protocol revealed a phase-delayed sleep-wake propensity cycle, low sleep continuity (ultradian 'bouts'), and very little slow-wave sleep and slow-wave activity (0.75-4.5 Hz). Switching treatment to the atypical neuroleptic clozapine improved both the circadian organization of the rest-activity cycle and the patient's clinical state. This observation can be conceptualized in terms of the two-process model of sleep regulation. High-dose haloperidol treatment may have lowered the circadian alertness threshold, whereas clozapine augmented circadian amplitude (perhaps through its high affinity to dopamine D4 and serotonin 5HT7 receptors in the suprachiasmatic nuclei). Measurement of the circadian rest-activity cycle may be a useful non-invasive method to follow functional consequences of neuroleptic treatment.

Topics: Adult; Antipsychotic Agents; Bed Rest; Body Temperature; Catatonia; Chronic Disease; Circadian Rhythm; Clozapine; Haloperidol; Humans; Male; Melatonin; Motor Activity; Recurrence; Rest; Schizophrenia; Sleep; Time Factors

Topics: Catatonia; Clozapine; Diagnosis, Differential; Humans; Lorazepam; Neuroleptic Malignant Syndrome

Neuroleptic malignant syndrome (NMS), a rare but serious side effect of psychotropic drugs, is usually attributed to blockade of striatal and hypothalamic dopaminergic tracts. Clozapine is an atypical antipsychotic that has minimal extrapyramidal effects and might not be expected to cause NMS. The authors report the development of NMS in a 30-year-old white man after three 25-mg clozapine doses. To their knowledge, this is the first case of NMS linked with clozapine in which concurrent psychotropic medications cannot be implicated.

Topics: Adult; Catatonia; Clozapine; Dose-Response Relationship, Drug; Humans; Male; Neuroleptic Malignant Syndrome; Psychotic Disorders

According to Venables the span of psychotic processes extends from a low level of arousal with an increased reactivity toward sensory stimuli to a high level of arousal with a reduced reactivity toward sensory stimuli. The level of arousal and the degree of reactivity, or breadth of attention, are apparently controlled by a regulatory mechanism which increases the threshold for sensory input in threatening situations. Any factor producing an electroencephalographic arousal reaction leads to a narrowing of attention. Underestimation of the size of a given object is an expression of such a reduction in the span of attention. Various authors have found a reduction in size-constancy in schizophrenics, in particular in patients exhibiting a merkedly reduced contact with their environment. A model is described in which a strong sensory stimulus induces a state of immobilization in rats treated with a low dose of morphine. Electroencephalographic recordings show that the initial state of arousal induced by peripheral stimulation is replaced by high-amplitude slow-waves and spindles as the state of immobilization develops. The current results suggest that the sensory stimulation leads to excitation of the ascending reticular formation and via the Centrum medianum and the Nucleus centralis, to activation of the striatal system, resulting in catalepsy. It would thus appear that the reticular formation and the striatum alternate in excercising a control function over the state of arousal. This would be a logical way of limiting over-reaction, which can be demonstrated most simply on the motoric response. It seems justified, therefore, to assume a relationship between catatonic stupor and the immobilization induced by stimulation. This concept is supported by the observation that of all the compounds investigated only clozapine is capable of inhibiting the immobilization in the rat model. Clozapine is a powerful antipsychotic agent with a pronounced inhibitory effect both on the reticular arousal reaction and on the schizophrenic catatonia.

Topics: Animals; Arousal; Behavior, Animal; Catatonia; Clozapine; Disease Models, Animal; Humans; Rats; Schizophrenia