Back to Search
Start Over
Non-Psychosis Symptoms of Clozapine Withdrawal: a Systematic Review.
- Source :
-
East Asian archives of psychiatry : official journal of the Hong Kong College of Psychiatrists = Dong Ya jing shen ke xue zhi : Xianggang jing shen ke yi xue yuan qi kan [East Asian Arch Psychiatry] 2023 Jun; Vol. 33 (2), pp. 44-64. - Publication Year :
- 2023
-
Abstract
- Objective: 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.<br />Methods: 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.<br />Results: 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.<br />Conclusions: 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.<br />Competing Interests: As an editor of the journal, SKW Chan was not involved in the peer review process. Other authors have disclosed no conflicts of interest.
- Subjects :
- Humans
Cholinergic Agents therapeutic use
Antipsychotic Agents adverse effects
Catatonia chemically induced
Catatonia complications
Catatonia drug therapy
Clozapine adverse effects
Schizophrenia drug therapy
Schizophrenia complications
Substance Withdrawal Syndrome etiology
Substance Withdrawal Syndrome diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 2224-7041
- Volume :
- 33
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- East Asian archives of psychiatry : official journal of the Hong Kong College of Psychiatrists = Dong Ya jing shen ke xue zhi : Xianggang jing shen ke yi xue yuan qi kan
- Publication Type :
- Academic Journal
- Accession number :
- 37400227
- Full Text :
- https://doi.org/10.12809/eaap2261