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A case report of cholinergic rebound syndrome following abrupt low-dose clozapine discontinuation in a patient with type I bipolar affective disorder
- Source :
- BMC Psychiatry, Vol. 19, No 73 (2019) pp. 1-5, BMC Psychiatry, Vol 19, Iss 1, Pp 1-5 (2019), BMC Psychiatry
- Publication Year :
- 2019
-
Abstract
- Background 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. Case presentation 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. Conclusions 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.
- Subjects :
- Male
Pediatrics
medicine.medical_specialty
Bipolar Disorder
Catatonia
medicine.drug_class
lcsh:RC435-571
Cholinergic Agents
Case Report
Withdrawal syndromes
03 medical and health sciences
ddc:616.89
0302 clinical medicine
lcsh:Psychiatry
Case report
medicine
Humans
Withdrawal syndromes-cholinergic rebound syndrome-low dose clozapine -bipolar affective disorder-Pharmacodynamic properties-overlapping switch strategies-case report
030212 general & internal medicine
Clozapine
Aged
Risperidone
ddc:617
business.industry
Mood stabilizer
Pharmacodynamic properties
medicine.disease
Overlapping switch strategies
Biperiden
Substance Withdrawal Syndrome
030227 psychiatry
Discontinuation
Psychiatry and Mental health
Withholding Treatment
Schizophrenia
Low dose clozapine
Quetiapine
Cholinergic rebound syndrome
business
Bipolar affective disorder
Antipsychotic Agents
medicine.drug
Subjects
Details
- Language :
- English
- ISSN :
- 1471244X
- Database :
- OpenAIRE
- Journal :
- BMC Psychiatry, Vol. 19, No 73 (2019) pp. 1-5, BMC Psychiatry, Vol 19, Iss 1, Pp 1-5 (2019), BMC Psychiatry
- Accession number :
- edsair.doi.dedup.....7744807f3ebeee5d9d1708e3bba222ce