Abstract：
BACKGROUND: Cholinergic discontinuation symptoms, also known as \"cholinergic rebound,\" from abrupt clozapine discontinuation are characterized by a range of somatic and psychiatric symptoms.
OBJECTIVE: The objective of this study was to describe the clinical features and management options for clozapine withdrawal-associated cholinergic rebound syndrome (henceforth referred to as CWCRS) and present an illustrative case report.
METHODS: Based on a literature search of the databases PubMed, OVID Medline, and Embase as well as reviewing reference lists of relevant past reviews, we carried out a systematic review of case reports on the management of CWCRS from 1946 to 2023.
RESULTS: We identified 10 previously published articles on the clinical management of CWCRS, with a total of 18 patients (6 female, 12 male) with an average age of 43 years (standard deviation 14). Half of the patients had a history of tardive dyskinesia. The mean dose of clozapine before discontinuation was 351 mg/day, with duration of clozapine treatment ranging from 3 weeks to 9 years. Clozapine was the most effective treatment, followed by benztropine.
CONCLUSIONS: Given the small number of cases and the nonexperimental nature of the available studies, this review could not provide reliable data to guide management of CWCRS. The findings, however, suggest that clozapine may be more effective than other commonly used treatment options. With the high rates of discontinuation among patients on clozapine, there is a pressing need for further research into the epidemiology, natural history, and management of clozapine withdrawal syndromes.
OBJECTIVE: The objective of this study was to describe the clinical features and management options for clozapine withdrawal-associated cholinergic rebound syndrome (henceforth referred to as CWCRS) and present an illustrative case report.
METHODS: Based on a literature search of the databases PubMed, OVID Medline, and Embase as well as reviewing reference lists of relevant past reviews, we carried out a systematic review of case reports on the management of CWCRS from 1946 to 2023.
RESULTS: We identified 10 previously published articles on the clinical management of CWCRS, with a total of 18 patients (6 female, 12 male) with an average age of 43 years (standard deviation 14). Half of the patients had a history of tardive dyskinesia. The mean dose of clozapine before discontinuation was 351 mg/day, with duration of clozapine treatment ranging from 3 weeks to 9 years. Clozapine was the most effective treatment, followed by benztropine.
CONCLUSIONS: Given the small number of cases and the nonexperimental nature of the available studies, this review could not provide reliable data to guide management of CWCRS. The findings, however, suggest that clozapine may be more effective than other commonly used treatment options. With the high rates of discontinuation among patients on clozapine, there is a pressing need for further research into the epidemiology, natural history, and management of clozapine withdrawal syndromes.
摘要：
背景：胆碱能停药症状，也被称为胆碱能反弹，氯氮平突然停药的特点是一系列躯体和精神症状。
目的：描述氯氮平戒断相关胆碱能反弹综合征（以下称为CWCRS）的临床特征和治疗方案，并提供说明性病例报告。
方法：基于对PubMed数据库的文献检索，OVIDMedline,和Embase以及审查相关过去审查的参考清单，我们对1946年至2023年CWCRS管理的病例报告进行了系统回顾.
结果：我们确定了10篇以前发表的关于CWCRS临床管理的文章，共有18名患者(6名女性，12名男性），平均年龄43岁（SD14）。一半的患者有迟发性运动障碍病史。停药前氯氮平的平均剂量为351mg/天，氯氮平治疗的持续时间为3周至9年。氯氮平是最有效的治疗方法,其次是苯托品。
结论：鉴于现有研究的病例数较少且非实验性，本综述无法提供可靠的数据来指导CWCRS的管理.然而，调查结果，提示氯氮平可能比其他常用治疗方案更有效.由于服用氯氮平的患者停药率高，迫切需要进一步研究流行病学，自然史,以及氯氮平戒断综合征的治疗。
目的：描述氯氮平戒断相关胆碱能反弹综合征（以下称为CWCRS）的临床特征和治疗方案，并提供说明性病例报告。
方法：基于对PubMed数据库的文献检索，OVIDMedline,和Embase以及审查相关过去审查的参考清单，我们对1946年至2023年CWCRS管理的病例报告进行了系统回顾.
结果：我们确定了10篇以前发表的关于CWCRS临床管理的文章，共有18名患者(6名女性，12名男性），平均年龄43岁（SD14）。一半的患者有迟发性运动障碍病史。停药前氯氮平的平均剂量为351mg/天，氯氮平治疗的持续时间为3周至9年。氯氮平是最有效的治疗方法,其次是苯托品。
结论：鉴于现有研究的病例数较少且非实验性，本综述无法提供可靠的数据来指导CWCRS的管理.然而，调查结果，提示氯氮平可能比其他常用治疗方案更有效.由于服用氯氮平的患者停药率高，迫切需要进一步研究流行病学，自然史,以及氯氮平戒断综合征的治疗。
