Remission of irreversible aripiprazole-induced tardive dystonia with clozapine: a case report.
BACKGROUND
Aripiprazole can cause irreversible tardive dystonia in some individuals, and additional intervention is sometimes needed. Here, we report the first case of aripiprazole-induced irreversible tardive dystonia in which complete recovery of motor function was achieved using the antipsychotic drug clozapine.


METHODS
A 24-year-old man with bipolar disorder was treated with aripiprazole and gradually developed tardive dystonia. Thorough medical and neurological examinations were performed to rule out other possible causes of tardive dystonia. Clozapine was administered when the patient did not improve following long-term withdrawal of aripiprazole or adjuvant medications. Before administration of clozapine, the patient was experiencing severe dystonia as assessed by the Extrapyramidal Symptom Rating Scale. Dystonic symptoms began to improve about 1 month after starting administration of clozapine and were completely resolved 3 months after clozapine administration.


CONCLUSIONS
Clinicians should note the risk of aripiprazole-induced tardive dystonia and consider clozapine as an alternative and effective treatment modality in cases of irreversible tardive dystonia, particularly when concomitant treatment of psychotic symptoms is required.
Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea. biophilia1@paran.com.|Department of Psychiatry, Ulsan University Hospital, 877 Bangeojinsunhwan-doro, Dong-gu, Ulsan, Republic of Korea. biophilia1@paran.com.
Soohyun
S
Joe
Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea. drpark98@naver.com.
Jangho
J
Park
Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea. jongshox@gmail.com.
Jongseok
J
Lim
Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea. choong10000@hanmail.net.
Choongman
C
Park
Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea. dreye@chol.com.
Joonho
J
Ahn
D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000068180:Aripiprazole / Q000009:adverse effects*; D001714:Bipolar Disorder / Q000188:drug therapy*; D003024:Clozapine / Q000627:therapeutic use*; D004409:Dyskinesia, Drug-Induced / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male; D009069:Movement Disorders / Q000188:drug therapy / Q000209:etiology*; D009460:Neurologic Examination; D011618:Psychotic Disorders / Q000188:drug therapy; D016896:Treatment Outcome; D055815:Young Adult
D014150:Antipsychotic Agents; D000068180:Aripiprazole; D003024:Clozapine