Table 2.
Published reports of clozapine withdrawal catatonia
| Study | Age | Gender | Psychiatric/neurologic diagnoses | Clozapine dose prior to discontinuation | Duration of use | Time until symptoms | Psychotic symptoms | Autonomic symptoms | Succesful treatment | Time to response | Unsuccesful treatment | Scale used for diagnosis | DSM-V criteria met |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Parsa et al.49 | 25 | M | Schizophrenia | 225 mg | 5 months | 7 days | Yes (hallucinations) | No | Melperone (partial), loxapine (partial) | 6 weeks (but never returning to baseline) | Fluphenazine, ECT, haloperidol | No | No |
| Lee and Robertson50 | 30 | M | Schizophrenia | 350 mg | 14 months | 36 h | Yes (thought disorder) | Yes (diaphoresis, fever, elevated blood pressure, tachycardia, tachypnea) | Clozapine | 3 weeks | Pimozide, haloperidol, chlorpromazine, clonazepam, benztropine, lorazepam | No | Yes |
| Yeh et al.51 | 55 | M | Schizophrenia | 400 mg | 6 years | <7 days | Yes (hallucinations) | Yes (diaphoresis, flushed face, bradycardia and tachycardia) | Clozapine, trihexyphenidyl | 7 days | x | Yes (BFCRS) | Yes |
| Hung et al.52 | 42 | F | Schizophrenia | 500 mg | Not specified | 14 days | Yes (hallucinations, delusions) | No | Clozapine | Not specified | Lorazepam, diazepam, ECT | No | No |
| Kalogeropoulou et al.53 | 37 | F | Schizophrenia | 350 mg | 10 years | <7 days | Yes (disorganized speech and behavior) | Yes (fever) | Clozapine | Not specified | Lorazepam, risperidone, amisulpride | No | Yes |
| Bastiampillai et al.29 | 58 | F | Schizoaffective disorder | 150 mg | 4 years | 3 days | No | Yes (fever, diaphoresis, fluctuating blood pressure) | ECT | 10 ECT sessions | Lorazepam | No | Yes |
| Thanasan and Jambunathan54 | “Middle aged” | M | Schizoaffective disorder | 200 mg | 5 years | 7 days | Yes (hallucinations, delusions) | Yes (fever, fluctuating blood pressure, tachycardia) | Bromocriptine, “anticholinergic”, diazepam | 12 days | x | No | No |
| Wadekar and Syed55 | 49 | F | Schizophrenia | 550 mg | “Many years” | 5 days | No | No | Clozapine | 2 days | Lorazepam, benazepril, olanzapine | Yes (BFCRS) | No |
| Dhillon et al.56 | 61 | F | Schizoaffective disorder | 400 mg | 16 years | Not specified | Yes (positive symptoms) | No | Aripiprazole, ECT | Not specified | x | No | No |
| Kanagasundram and Chengappa57 | 45 | F | Schizophrenia | 400 mg | 7 years | “Rapidly (within days)” | Yes (hallucinations, delusions) | Yes (fever) | Amisulpride | 2 days | Haloperidol | No | Yes |
| Kumar et al.58 | 29 | M | Schizophrenia | 250 mg | 3 months | 2 days | No | No | Lorazepam, ECT | 4 ECT treatments | x | No | Yes |
| Cerit et al.59 | 46 | M | Schizophrenia | 200 mg | 10 years | 5 days | Yes (hallucinations, delusions) | Yes (fever, tachycardia) | Clozapine, lorazepam | 2 days | ECT | Yes (BFCRS) | No |
| Wang et al.44 | 39 | F | Schizophrenia | 200 mg | 8 years | “Immediate” | Yes (hallucinations, delusions) | No | Clozapine | Not specified | x | Yes (BFCRS) | Yes |
| Erol et al.60 | 27 | M | Schizophrenia | 150 mg | 4 years | 5 days | Yes (hallucinations, delusions) | Yes (fever, tachycardia, labile blood pressure, diaphoresis) | ECT | 1 ECT treatment | Diazepam | No | Yes |
| Koch et al.61 | 33 | F | Schizophrenia | 250 mg | 6 months | 14 days | Yes (hallucinations) | Yes (fever) | Olanzapine, lorazapam, ECT | 10 ECT sessions, 4 weeks | Quetiapine | No | Yes |
| Ariyasinghe and Abeyasinghe62 | 44 | F | Schizophrenia | Not specified | 10 years | “Recently” after discontinuation | No | No | Clozapine | 1 week | x | No | Yes |
| Saddawi-Konefka et al.46 | 48 | M | Schizoaffective disorder | Not specified | Not specified | 7 days | No | No | ECT | 8 ECT treatments | Lorazepam | No | Yes |
| Koychev et al.63 | 22 | M | Psychotic Illness | 300 mg | 5 weeks | 4 days | No | No | Lorazepam | 7 days (rigidity improved in 45 min) | x | No | No |
| Ingole et al.64 | 44 | M | Schizoaffective disorder | 200 mg | Not specified | 7 days | No | Yes (autonomic instability) | Lorazepam | 3 days | x | Yes (BFCRS) | Yes |
| Bilbily et al.30 | 38 | M | Schizophrenia | 400 mg | 7 years | 10 days | No | No | Lorazepam, Clozapine | 3 months | Haloperidol, Diphenhydramine | No | Yes |