# 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.

## Key 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.