Very-Low-Dose Clozapine as Maintenance Treatment for Psychosis in a Patient With Dementia With Lewy Bodies: A Case Report

TL;DR

A 72-year-old woman with dementia and psychosis showed improvement with very-low-dose clozapine after other treatments failed.

Contribution

Demonstrates clozapine's effectiveness at very low doses for managing psychosis in dementia with Lewy bodies.

Findings

Very-low-dose clozapine stabilized psychotic symptoms and improved motor function in a DLB patient.

Higher doses of olanzapine and levodopa-carbidopa were ineffective or caused adverse effects.

Severe hypotension occurred initially but resolved with dose reduction to 6.25mg.

Abstract

Dementia with Lewy bodies (DLB) is a neurodegenerative disorder characterized by cognitive decline, motor symptoms, and other neuropsychiatric manifestations, including visual hallucinations, delusions and disorganized thought processes that can configure a psychotic episode. Managing psychosis in DLB is challenging due to hypersensitivity to antipsychotics. This case report describes a 72-year-old female patient with DLB who presented with psychosis and Parkinsonian symptoms. Initial management with olanzapine (10 mg) was effective for psychosis but led to motor worsening. The inclusion of levodopa-carbidopa and reduction of olanzapine were not effective in the resolution of symptoms. Transition to clozapine performed and resulted in stabilization of psychotic symptoms and motor symptoms improvement. Initially, the patient presented with severe symptomatic hypotension, that required the tapering off to a very low dose (6.25mg) without severe adverse effects. This report highlights the utility of very-low dose clozapine in managing psychosis in DLB and discusses therapeutic challenges.

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