An Unusual Case of Delirium after Restarting Clozapine

다국어 초록 (Multilingual Abstract)

Clozapine is a gold standard medication and drug of choice in refractory schizophrenia. Among many of its fatal side effects, delirium is less reported and inconsistently recognized by clinicians. We here present a case of delirium which emerged during retreatment with clozapine in a patient of paranoid schizophrenia. A patient diagnosed with paranoid schizophrenia, was restarted on clozapine after he left medications and became symptomatic. He was delirious on 22nd day after clozapine was restarted.
Clozapine was stopped and the patient was managed with standard treatment for delirium. After one week interval, clozapine was restarted. Delirium was not noted till 6 weeks of his hospital stay. Clozapine induced central anticholinergic toxicity or clozapine induced seizure might cause delirium in index case. Limited literature exist delirium with clozapine. Clinicians must have high index of suspicion to detect delirium during clozapine therapy. More researches should focus to explore the association between delirium and clozapine.

참고문헌 (Reference)

1 Wilkins-Ho M, "Toxic delirium with low-dose clozapine" 42 : 429-430, 1997

2 Gaertner HJ, "Side effects of clozapine" 99 (99): S97-S100, 1989

3 Schuster P, "Reversal by physostigmine of clozapine-induced delirium" 10 : 437-441, 1977

4 Schuster P, "Letter:Reversal by physostigmine of clozapine-induced delirium" 1 : 37-38, 1976

5 Kumar S, "ECT and Clozapine combination producing delirium : A Case Report" 45 : 193-, 2003

6 Benckhuijsen JA, "Delirium on re-starting clozapine after a short break in treatment" 49 : 661-665, 2007

7 Centorrino F, "Delirium during clozapine treatment: incidence and associated risk factors" 36 : 156-160, 2003

8 Jackson CW, "Delirium associated with clozapine and benzodiazepine combinations" 7 : 139-141, 1995

9 Manjunatha N, "Delayed onset, protracted delirium and aspiration pneumonitis associated with a combination of clozapine and electroconvulsive therapy" 33 : 80-82, 2011

10 Iqbal MM, "Clozapine: a clinical review of adverse effects and management" 15 : 33-48, 2003

11 Shankar BR, "Clozapine-induced delirium" 20 : 239-240, 2008

12 Stanilla JK, "Clozapine withdrawal resulting in delirium with psychosis: a report of three cases" 58 : 252-255, 1997

13 Kane J, "Clozapine for the treatment-resistant schizophrenic. A double-blind comparison with chlorpromazine" 45 : 789-796, 1988

14 Baweja R, "Clozapine associated delirium" 15 : 71-72, 2010

15 Szymanski S, "Anticholinergic delirium caused by retreatment with clozapine" 148 : 1752-, 1991

16 Wong OF, "An unusual cause of delirium in a psychiatric patient: abrupt clozapine discontinuation" 17 : 163-167, 2010