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Article: Non-Psychosis Symptoms of Clozapine Withdrawal: a Systematic Review
Title | Non-Psychosis Symptoms of Clozapine Withdrawal: a Systematic Review |
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Authors | |
Keywords | Catatonia Clozapine Dyskinesias Dystonia Serotonin syndrome Substance withdrawal syndrome |
Issue Date | 1-Jan-2023 |
Publisher | Hong Kong Academy of Medicine Press |
Citation | East Asian Archives of Psychiatry, 2023, v. 33, n. 2, p. 44-64 How to Cite? |
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. 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. 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. 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. |
Persistent Identifier | http://hdl.handle.net/10722/345765 |
ISSN | 2023 SCImago Journal Rankings: 0.364 |
DC Field | Value | Language |
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dc.contributor.author | Yee, Beryl | - |
dc.contributor.author | Looi, Jeffrey CL | - |
dc.contributor.author | Agaciak, Madelyn | - |
dc.contributor.author | Allison, Stephen | - |
dc.contributor.author | Chan, Sherry Kit Wa | - |
dc.contributor.author | Bastiampillai, Tarun | - |
dc.date.accessioned | 2024-08-28T07:40:33Z | - |
dc.date.available | 2024-08-28T07:40:33Z | - |
dc.date.issued | 2023-01-01 | - |
dc.identifier.citation | East Asian Archives of Psychiatry, 2023, v. 33, n. 2, p. 44-64 | - |
dc.identifier.issn | 2078-9947 | - |
dc.identifier.uri | http://hdl.handle.net/10722/345765 | - |
dc.description.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. 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. 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. 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. | - |
dc.language | eng | - |
dc.publisher | Hong Kong Academy of Medicine Press | - |
dc.relation.ispartof | East Asian Archives of Psychiatry | - |
dc.rights | This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. | - |
dc.subject | Catatonia | - |
dc.subject | Clozapine | - |
dc.subject | Dyskinesias | - |
dc.subject | Dystonia | - |
dc.subject | Serotonin syndrome | - |
dc.subject | Substance withdrawal syndrome | - |
dc.title | Non-Psychosis Symptoms of Clozapine Withdrawal: a Systematic Review | - |
dc.type | Article | - |
dc.identifier.doi | 10.12809/eaap2261 | - |
dc.identifier.pmid | 37400227 | - |
dc.identifier.scopus | eid_2-s2.0-85164017048 | - |
dc.identifier.volume | 33 | - |
dc.identifier.issue | 2 | - |
dc.identifier.spage | 44 | - |
dc.identifier.epage | 64 | - |
dc.identifier.eissn | 2224-7041 | - |
dc.identifier.issnl | 2078-9947 | - |