Clozapine for Patients With Intellectual Disabilities: A Case Series Illustrating the Clinical Potentials

TL;DR

This paper explores the use of clozapine to treat challenging behaviors in patients with intellectual disabilities when other treatments fail.

Contribution

The study presents five case scenarios showing clozapine's potential for treatment-resistant behaviors in intellectual disability.

Findings

Four out of five patients showed significant reduction in challenging behaviors with clozapine.

Two patients experienced reduced psychotic or affective symptoms.

Side effects were mild and manageable with point-of-care monitoring.

Abstract

Challenging behaviours (CBs) are common in patients with intellectual disabilities (IDs) and diagnosing an underlying primary psychiatric disorder is often difficult. Even though many respond to non-pharmacological or pharmacological interventions persistent aggressive and self-injurious behaviour occur and no treatment-resistant guideline exists. We aim to present clinical scenarios regarding patients with ID and persistent CB with or without a primary psychiatric disorder where clozapine could be considered.

We present five patients with ID with persistent CB with or without a primary psychiatric disorder treated with clozapine. Four of the five patients responded well to clozapine treatment with markedly decreased CB, and two patients had reduced psychotic- or affective symptoms. Side-effects were mild and manageable. Haematological monitoring was performed with a point-of-care (POC) test device.

We show that clozapine can be efficacious in persistent CB and/or treatment-resistant psychiatric symptoms in patients with ID. Monitoring and managing side-effects were possible.

We suggest that clozapine should be considered in patients with ID regardless of a primary psychiatric disorder when CB does not respond to non-pharmacological and first line pharmacological treatment. It is possible to monitor and manage side-effects with a systematic approach including the use of POC testing.