Umstellung von Clozapin auf Quetiapin ohne Rebound-Psychose

Zusammenfassung

Anliegen: Nach raschem Absetzen von Clozapin treten häufig Rebound-Psychosen auf. Mögliche Ursachen sind die veränderte Affinität des D₂-Rezeptors und eine verstärkte Dopaminausschüttung. Methodik: Wir berichten einen Fall, der mit Clozapin und Aripiprazol behandelt wurde und bei dem man Clozapin abrupt absetzte. Clozapin wurde durch Quetiapin substituiert. Ergebnisse: Über einen Zeitraum von zehn Wochen trat keine Rebound-Psychose auf. Schlussfolgerungen: Die Kombination aus Aripiprazol und Quetiapin schien die Dopaminhypersensitivität am D₂-Rezeptor wirkungsvoll ausgleichen zu können.

Abstract

Objective: After rapid discontinuation of clozapine treatment rebound psychosis have been reported. Preexposure of D₂ receptors to clozapine may alter their affinity to endogenous dopamine. Clozapine withdrawal may also lead dysfunctional NMDA-receptors to cause dopamine release in the striatum. Method: We report a case of a schizophrenic patient treated with clozapine 200 mg and aripiprazole 15 mg per day. After rapid clozapine discontinuation we added quetiapine up to 700 mg daily. Results: No rebound psychosis occurred. Even ten weeks after switching to quetiapine the patient's condition remained stable in the Brief Psychiatric Rating Scale. Conclusions: The combination of aripiprazole and quetiapine seemed to control supersensitivity effects at the D₂ receptor after clozapin withdrawal in this case.

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