{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T07:18:19Z","timestamp":1791357499156,"version":"4.3.1"},"reference-count":18,"publisher":"Royal College of Psychiatrists","issue":"3","license":[{"start":{"date-parts":[[2019,5,22]],"date-time":"2019-05-22T00:00:00Z","timestamp":1558483200000},"content-version":"unspecified","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BJPsych open"],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:sec id=\"S2056472419000310_sec_a1\">\n\t    <jats:title>Summary<\/jats:title>\n\t    <jats:p>\u2018Rebound\u2019 or \u2018withdrawal\u2019 symptoms are frequently observed after a sudden discontinuation of clozapine. We describe a patient with treatment-resistant schizoaffective disorder who developed agranulocytosis on clozapine but was successfully switched to treatment with olanzapine with no deterioration in her condition. We put forward three possible theories which may have accounted for the lack of rebound symptoms in this patient: the pharmacological profile of olanzapine, the anticholinergic effects of hyoscine hydrobromide, and the possibility that this patient may not be treatment-resistant and so have a reduced risk of rebound psychosis due to displaying a different pathophysiology.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2056472419000310_sec_a2\">\n\t    <jats:title>Declaration of interest<\/jats:title>\n\t    <jats:p>None.<\/jats:p>\n\t  <\/jats:sec>","DOI":"10.1192\/bjo.2019.31","type":"journal-article","created":{"date-parts":[[2019,5,22]],"date-time":"2019-05-22T06:52:12Z","timestamp":1558507932000},"source":"Crossref","is-referenced-by-count":5,"title":["Closure beyond clozapine: successfully averting rebound symptoms in a patient with schizoaffective disorder and agranulocytosis"],"prefix":"10.1192","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1447-6838","authenticated-orcid":false,"given":"Alastair","family":"Green","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Stephenson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eromona","family":"Whiskey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sukhi S.","family":"Shergill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"170","published-online":{"date-parts":[[2019,5,22]]},"reference":[{"key":"S2056472419000310_ref18","doi-asserted-by":"publisher","DOI":"10.2147\/NDT.S116029"},{"key":"S2056472419000310_ref15","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/22.4.591"},{"key":"S2056472419000310_ref14","doi-asserted-by":"publisher","DOI":"10.1097\/00004714-199910000-00007"},{"key":"S2056472419000310_ref12","doi-asserted-by":"publisher","DOI":"10.1016\/S0006-3223(00)01026-X"},{"key":"S2056472419000310_ref11","doi-asserted-by":"publisher","DOI":"10.1038\/s41398-018-0192-9"},{"key":"S2056472419000310_ref16","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbt137"},{"key":"S2056472419000310_ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.pnpbp.2003.09.033"},{"key":"S2056472419000310_ref3","unstructured":"National Institute for Health and Care Excellence (NICE). Psychosis and Schizophrenia in Adults: Prevention and Management (CG178). NICE, 2014 (https:\/\/www.nice.org.uk\/guidance\/cg178\/chapter\/1-Recommendations)."},{"key":"S2056472419000310_ref1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0031660"},{"key":"S2056472419000310_ref17","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-016-1177-y"},{"key":"S2056472419000310_ref9","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.2165\/00023210-200519120-00006","article-title":"Effect of anticholinergics in preventing acute deterioration in patients undergoing abrupt clozapine withdrawal","volume":"19","author":"Sepp\u00e4l\u00e4","year":"2005","journal-title":"CNS Drugs"},{"key":"S2056472419000310_ref4","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.169.4.483"},{"key":"S2056472419000310_ref2","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1988.01800330013001"},{"key":"S2056472419000310_ref5","volume-title":"The Maudsley Prescribing Guidelines in Psychiatry","author":"Taylor","year":"2018"},{"key":"S2056472419000310_ref6","doi-asserted-by":"publisher","DOI":"10.1016\/0006-3223(95)00215-4"},{"key":"S2056472419000310_ref7","article-title":"Catatonia secondary to sudden clozapine withdrawal: a case with three repeated episodes and a literature review","volume":"2017","author":"Bilbily","year":"2017","journal-title":"Case Rep Psychiatry"},{"key":"S2056472419000310_ref10","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.v59n0906"},{"key":"S2056472419000310_ref8","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.156.6.876"}],"container-title":["BJPsych Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S2056472419000310","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,5,22]],"date-time":"2019-05-22T06:52:15Z","timestamp":1558507935000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S2056472419000310\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,5]]},"references-count":18,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2019,5]]}},"alternative-id":["S2056472419000310"],"URL":"https:\/\/doi.org\/10.1192\/bjo.2019.31","relation":{},"ISSN":["2056-4724"],"issn-type":[{"value":"2056-4724","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,5]]},"article-number":"e43"}}