Discontinuation of an antipsychotic medication (neuroleptic) may be followed by a variety of clinical signs and symptoms. Some patients may have no or minimal symptoms while others may be severely affected.
Mechanisms:
(1) cholinergic rebound
(2) mesolimbic supersensitivity
Risk factors:
(1) abrupt discontinuation without tapering of dose
(2) prolonged use
Clinical features:
(1) relapse of psychosis
(2) delirium
(3) insomnia
(4) restlessness or agitation
(5) nausea and vomiting
(6) anorexia
(7) diarrhea
(8) rhinorrhea
(9) diaphoresis (sweating)
(10) myalgias
(11) paresthesias
(12) anxiety
(13) generalized malaise
(14) headache
Differential diagnosis:
(1) neuroleptic malignant syndrome
A patient should be monitored for these findings following discontinuation of a neuroleptic,
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