title: Severe withdrawal akathisia following neuroleptic discontinuation successfully controlled by clozapine.
abstract: Akathisia is one of the most distressing side effects of neuroleptic treatment. It is usually managed by manipulating the neuroleptic dose and administering anti-akathisic compounds (beta-blockers, anticholinergics, serotonin antagonists). However, the pathophysiological background of withdrawal akathisia which follows the discontinuation of neuroleptic treatment remains unclear, and there is as yet no adequate treatment. We report a case of severe withdrawal akathisia associated with suicidal and autoaggressive behaviour during a gradual transition from perphenazine/trihexyphenidyl to clozapine. The akathisia was effectively managed by titration of clozapine (maximum dose 200 mg/day) Thereafter, reduction of the clozapine dose resulted in a recurrence of the akathisia, and the resumption of clozapine dose was accompanied by full amelioration of symptoms. We suggest that the antiserotonergic properties of clozapine were responsible for its anti-akathisic effect. Differences in the treatment of acute and withdrawal types of akathisia are emphasized.
authors.affiliation: Tirat Carmel Mental Health Center, Haifa, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Poyurovsky
authors.forename: H
authors.initials: H
authors.lastname: Hermesh
authors.forename: A
authors.initials: A
authors.lastname: Weizman
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003024:Clozapine / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011595:Psychomotor Agitation / Q000188:drug therapy*; D012559:Schizophrenia / Q000188:drug therapy*; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy*
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine