Antipsychotic withdrawal–induced catatonia: A four-case series

Catatonia is a severe neuropsychiatric syndrome that may emerge following abrupt discontinuation of antipsychotic medications, most commonly clozapine. We report a four-case series of patients with schizophrenia who developed withdrawal-induced catatonia following sudden cessation of clozapine, haloperidol, or risperidone. Clinical features included mutism, rigidity, posturing, excitement, autonomic instability, and altered responsiveness, with Bush–Francis Catatonia Rating Scale scores ranging from 15 to 18. Neuroleptic malignant syndrome, delirium, metabolic, and structural causes were systematically excluded. All patients showed marked improvement following lorazepam administration, confirming the diagnosis. One patient demonstrated partial response and required adjunctive electroconvulsive therapy. Gradual reintroduction of antipsychotics after resolution of catatonia resulted in sustained clinical stability without recurrence. This series highlights that withdrawal-induced catatonia is the potentially life-threatening but reversible condition that can occur across both typical and atypical antipsychotics. Early recognition, prompt benzodiazepine treatment, cautious antipsychotic reintroduction, and strict medication adherence are essential to prevent morbidity and mortality.