Clozapine has been reported to induce various withdrawal signs and a rapid onset psychotic reaction (supersensitivity psychosis), after cessation of chronic treatment. Catatonic features associated with discontinuing or decreasing clozapine have also been described in a few cases.

We report the case of a 37-year-old woman, who had already suffered from disorganized schizophrenia for 20 years, and in whom we diagnosed agitated catatonia with purposeless motor activity for four days followed by a catatonic stuporous state with marked hypokinesia, negativism, mutism, posturing, waxy flexibility, echo phenomena, refusal to eat or drink and stereotyped movements with mannerisms that lasted another four days. She also demonstrated fever and some changes in blood and serum parameters. After resolution of the catatonic symptoms the patient's behaviour and speech remained enormously disorganized. The symptoms occurred less than one week after discontinuation of clozapine treatment (350 mg). The patient was on clozapine for almost 10 years, had been stable and had a re-emergence of some psychotic symptoms twice when clozapine was decreased. She was treated with lorazepam and was then put on amisulpiride and risperidone (liquids), with no response of her psychotic symptoms. For that reason, reinstatement of clozapine was decided 40 days after admission and the patient recovered dramatically.

Catatonia occurred in our patient a few days after discontinuation of long-term clozapine treatment and it therefore could be caused by clozapine withdrawal itself. Clinicians should be alert to recognizing catatonia as a possible clozapine withdrawal phenomenon.