Closure beyond clozapine: Successfully averting rebound symptoms in a patient with schizoaffective disorder and agranulocytosis

Alastair Green; Thomas Stephenson; Eromona Whiskey; Sukhi S. Shergill

doi:10.1192/bjo.2019.31

Closure beyond clozapine: Successfully averting rebound symptoms in a patient with schizoaffective disorder and agranulocytosis

Alastair Green^*, Thomas Stephenson, Eromona Whiskey, Sukhi S. Shergill

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

Abstract

'Rebound' or 'withdrawal' symptoms are frequently observed after a sudden discontinuation of clozapine. We describe a patient with treatment-resistant schizoaffective disorder who developed agranulocytosis on clozapine but was successfully switched to treatment with olanzapine with no deterioration in her condition. We put forward three possible theories which may have accounted for the lack of rebound symptoms in this patient: the pharmacological profile of olanzapine, the anticholinergic effects of hyoscine hydrobromide, and the possibility that this patient may not be treatment-resistant and so have a reduced risk of rebound psychosis due to displaying a different pathophysiology.

Original language	English
Article number	e43
Journal	BJPsych Open
Volume	5
Issue number	3
DOIs	https://doi.org/10.1192/bjo.2019.31
Publication status	Published - 1 May 2019

Keywords

Agranulocytosis
Clozapine
Psychosis
Rebound psychosis
Treatment-resistant schizophrenia

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10.1192/bjo.2019.31

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title = "Closure beyond clozapine: Successfully averting rebound symptoms in a patient with schizoaffective disorder and agranulocytosis",

abstract = "'Rebound' or 'withdrawal' symptoms are frequently observed after a sudden discontinuation of clozapine. We describe a patient with treatment-resistant schizoaffective disorder who developed agranulocytosis on clozapine but was successfully switched to treatment with olanzapine with no deterioration in her condition. We put forward three possible theories which may have accounted for the lack of rebound symptoms in this patient: the pharmacological profile of olanzapine, the anticholinergic effects of hyoscine hydrobromide, and the possibility that this patient may not be treatment-resistant and so have a reduced risk of rebound psychosis due to displaying a different pathophysiology. ",

keywords = "Agranulocytosis, Clozapine, Psychosis, Rebound psychosis, Treatment-resistant schizophrenia",

author = "Alastair Green and Thomas Stephenson and Eromona Whiskey and Shergill, {Sukhi S.}",

note = "Funding Information: S.S.S. is supported by a European Research Council Consolidator Award (grant number 311686) and the National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. The funders had no role in study design, data collection, data analysis, data interpretation or writing of the report. Acknowledgements Publisher Copyright: {\textcopyright} The Royal College of Psychiatrists 2019.",

year = "2019",

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doi = "10.1192/bjo.2019.31",

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AU - Green, Alastair

AU - Stephenson, Thomas

AU - Whiskey, Eromona

AU - Shergill, Sukhi S.

N1 - Funding Information: S.S.S. is supported by a European Research Council Consolidator Award (grant number 311686) and the National Institute for Health Research Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. The funders had no role in study design, data collection, data analysis, data interpretation or writing of the report. Acknowledgements Publisher Copyright: © The Royal College of Psychiatrists 2019.

PY - 2019/5/1

Y1 - 2019/5/1

N2 - 'Rebound' or 'withdrawal' symptoms are frequently observed after a sudden discontinuation of clozapine. We describe a patient with treatment-resistant schizoaffective disorder who developed agranulocytosis on clozapine but was successfully switched to treatment with olanzapine with no deterioration in her condition. We put forward three possible theories which may have accounted for the lack of rebound symptoms in this patient: the pharmacological profile of olanzapine, the anticholinergic effects of hyoscine hydrobromide, and the possibility that this patient may not be treatment-resistant and so have a reduced risk of rebound psychosis due to displaying a different pathophysiology.

AB - 'Rebound' or 'withdrawal' symptoms are frequently observed after a sudden discontinuation of clozapine. We describe a patient with treatment-resistant schizoaffective disorder who developed agranulocytosis on clozapine but was successfully switched to treatment with olanzapine with no deterioration in her condition. We put forward three possible theories which may have accounted for the lack of rebound symptoms in this patient: the pharmacological profile of olanzapine, the anticholinergic effects of hyoscine hydrobromide, and the possibility that this patient may not be treatment-resistant and so have a reduced risk of rebound psychosis due to displaying a different pathophysiology.

KW - Agranulocytosis

KW - Clozapine

KW - Psychosis

KW - Rebound psychosis

KW - Treatment-resistant schizophrenia

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DO - 10.1192/bjo.2019.31

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AN - SCOPUS:85100935850

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VL - 5

JO - BJPsych Open

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IS - 3

M1 - e43

ER -

Closure beyond clozapine: Successfully averting rebound symptoms in a patient with schizoaffective disorder and agranulocytosis

Abstract

Keywords

UN SDGs

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