A case of depression manifesting incessant pacing and wandering following discontinuation of antipsychotic drugs due to neuroleptic malignant syndrome: A possible involvement of withdrawal akathisia

Abstract

A depressed 36-year-old woman manifesting a delusion of persecution was started on neuroleptics. In parallel with the increase of neuroleptics, she suffered from akathisia, such as wandering, and thereafter developed neuroleptic malignant syndrome. Thus, neuroleptics were discontinued. As a result, she manifested severer wandering, impairment of conversation, and unacceptable behavior (e.g. touching her stool) though neuroleptic malignant syndrome subsided. These symptoms improved following the administration of levomepromazine and amitriptyline. It seems difficult to regard these symptoms as just as prolongation of akathisia, since the level and frequency of akathisia increased. It also seems unlikely to regard these symptoms as those of agitated depression, since there were no complaints or irritability. On the other hand, it seems probable that 'withdrawal akathisia' occurred following the discontinuation of neuroleptics and the reinstituted levomepromazine improved the withdrawal phenomena consisting of severer wandering, impairment of conversation, and unacceptable behavior.