Antipsychotic Initiation and Cessation: A careful look at first break psychosis and subsequent treatment withdrawal
Location
LSUHSC-NO
Publication Date
April 2026
Start Date
9-4-2026 10:00 AM
End Date
9-4-2026 2:00 PM
Description
Psychiatric symptoms, such as paranoia, delusions, and hallucinations may arise from infectious, metabolic, or primary psychiatric causes. This complicates diagnosis and management for a patient presenting with an initial episode of psychosis. This case report follows a patient, Mr. J, a 37-year-old male with a history of HIV and generalized anxiety disorder, who presented to the hospital after endorsing hallucinations and paranoia with his outpatient psychiatrist. On the inpatient psychiatric unit, the patient was titrated to Risperidone 3 mg BID with minimal improvement in his symptoms and multiple behavioral PRNs. During his hospitalization, it was discovered he has Neurosyphilis, and he was transferred to inpatient medicine for treatment with IV Penicillin. After approximately four weeks of inpatient treatment with Risperidone, Depakote, and Ativan, the patient was discharged and did not pick up any psychiatric medications. Three days later, he presented to the hospital with confusion, disorientation, upper-extremity muscle stiffness, and a shuffling gait, without any clear psychotic symptoms. He was restarted on his discharge regimen of Risperidone, Depakote, and Ativan, alongside Benztropine for dystonia. Risperidone was slowly tapered with resolution of the neurological symptoms and no breakthrough psychosis. He was discharged on a short course of Ativan and Benztropine, and he currently remains stable outpatient on a low-dose Quetiapine for sleep and anxiety. This case raises concern for a medication-related movement or possible catatonia- spectrum condition after abrupt discontinuation of high dose antipsychotics. This patient's presentation to the hospital was likely related to withdrawal from Risperidone and Ativan, creating a difficult diagnostic picture, possibly related to Dopaminergic hypersensitivity or a hyperexcitable Central Nervous System. This case also underscores the importance of reassessing psychiatric diagnoses after identification of medical etiologies, thorough medical workups for a first episode of psychosis, and careful cessation of psychiatric medications to avoid severe withdrawal symptoms.
Recommended Citation
Kukreja, Yush; Hightower, Ross; Capone, Erin; and Bishop-Baier, Margaret, "Antipsychotic Initiation and Cessation: A careful look at first break psychosis and subsequent treatment withdrawal" (2026). Dept. of Psychiatry Research Symposium. 17.
https://digitalscholar.lsuhsc.edu/psych_rd/2026/posters/17
Antipsychotic Initiation and Cessation: A careful look at first break psychosis and subsequent treatment withdrawal
LSUHSC-NO
Psychiatric symptoms, such as paranoia, delusions, and hallucinations may arise from infectious, metabolic, or primary psychiatric causes. This complicates diagnosis and management for a patient presenting with an initial episode of psychosis. This case report follows a patient, Mr. J, a 37-year-old male with a history of HIV and generalized anxiety disorder, who presented to the hospital after endorsing hallucinations and paranoia with his outpatient psychiatrist. On the inpatient psychiatric unit, the patient was titrated to Risperidone 3 mg BID with minimal improvement in his symptoms and multiple behavioral PRNs. During his hospitalization, it was discovered he has Neurosyphilis, and he was transferred to inpatient medicine for treatment with IV Penicillin. After approximately four weeks of inpatient treatment with Risperidone, Depakote, and Ativan, the patient was discharged and did not pick up any psychiatric medications. Three days later, he presented to the hospital with confusion, disorientation, upper-extremity muscle stiffness, and a shuffling gait, without any clear psychotic symptoms. He was restarted on his discharge regimen of Risperidone, Depakote, and Ativan, alongside Benztropine for dystonia. Risperidone was slowly tapered with resolution of the neurological symptoms and no breakthrough psychosis. He was discharged on a short course of Ativan and Benztropine, and he currently remains stable outpatient on a low-dose Quetiapine for sleep and anxiety. This case raises concern for a medication-related movement or possible catatonia- spectrum condition after abrupt discontinuation of high dose antipsychotics. This patient's presentation to the hospital was likely related to withdrawal from Risperidone and Ativan, creating a difficult diagnostic picture, possibly related to Dopaminergic hypersensitivity or a hyperexcitable Central Nervous System. This case also underscores the importance of reassessing psychiatric diagnoses after identification of medical etiologies, thorough medical workups for a first episode of psychosis, and careful cessation of psychiatric medications to avoid severe withdrawal symptoms.