Clozapine withdrawal emergent dystonia, oculogyric crisis and rebound psychosis in a single patient

Abrupt clozapine withdrawal is heralded by both physiological and psychological symptoms requiring urgent management, out of which dystonic reactions have been reported by only two groups to date [Ahmed et al. 1998; Mendhekar and Duggal, 2006]. We present here the only case reported in the literature to manifest psychotic decompensation, oculogyric crisis and limb-axial dystonia in a single patient due to abrupt clozapine withdrawal and discuss the putative mechanisms underlying this unique presentation. Early recognition of this syndrome is important as symptomatic treatment alone runs the risk of recurrence of the withdrawal symptoms, as seen in our patient, unless clozapine is reinstituted promptly.