Korean J Psychopharmacol.  1998 Oct;9(2):188-192.

A Case of Atypical Neuroleptic Malignant Syndrome following Rebound Psychosis during Withdrawal of Clozapine

• Kim CH
• Lee HS

Abstract

We experienced one case of neuroleptic malignant syndrome (NMS) caused by a discontinuation of clozapine and rapid initiation of sulpiride and haloperidol injection. The patient was a 37-year-old man with a 15-year history of schizophrenia. He was maintained by clozapine (200mg/day) for more than one year. His clinical status was relatively stable at the tapering time of clozapine. On the 3rd day of clozapine tapering (100mg/day), insomnia, paranoid delusion, agitation, and irritability were observed. On the 7th day of clozapine tapering (clozapine, 25mg/day), he developed rebound psychosis. He was initiated on sulpiride 200mg/day. On the 5th day of sulpiride treatment (sulpiride, 600mg/day), he had mental confusion, leukocytosis, liver enzyme elevation, marked elevation in CPK (100,000 U/L), and prominent autonomic dysfunctions without severe muscle rigidity and high fever. A diagnosis of atypical NMS was made. He was transferred to intensive care unit (ICU) and managed conservatively. Complete recovery of NMS occured after 10 days. After he had been physically well for 1 week, and due to continued psychotic symptoms, he was restarted on clozapine at 25mg twice daily, which was gradually increased to 300mg/day, with no significant adverse effects noted in the next 18 weeks.

Keyword

Clozapine; Atypical neuroleptic malignant syndrome; Rebound psychosis

MeSH Terms

Adult
Clozapine*
Delusions
Diagnosis
Dihydroergotamine
Fever
Haloperidol
Humans
Intensive Care Units
Leukocytosis
Liver
Muscle Rigidity
Neuroleptic Malignant Syndrome*
Psychotic Disorders*
Schizophrenia
Sleep Initiation and Maintenance Disorders
Sulpiride
Clozapine
Dihydroergotamine
Haloperidol
Sulpiride