Clozapine 중단과정에서 반동정신병 발병 이후 유발된 비정형적 신경이완제악성증후군

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 (200 mg/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 (100 mg/day), insomnia, paranoid delusion, agitation, and irritability were observed. On the 7th day of clozapine tapering (clozapine, 25 mg/day), he developed rebound psychosis. He was initiated on sulpiride 200 mg/day. On the 5th day of sulpiride treatment (sulpiride, 600 mg/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 25 mg twice daily, which was gradually increased to 300 mg/day, with no significant adverse effects noted in the next 18 weeks.