Clozapine use in personality disorder and intellectual disabilities
| Published date | 02 November 2015 |
| Date | 02 November 2015 |
| DOI | https://doi.org/10.1108/AMHID-02-2015-0009 |
| Pages | 363-370 |
| Author | Reza Kiani,Asit Biswas,John Devapriam,Regi Tharian Alexander,Satheesh Kumar,Hayley Andrews,Samuel Joseph Tromans |
| Subject Matter | Health & social care,Learning & intellectual disabilities |
Clozapine use in personality disorder and
intellectual disabilities
Reza Kiani, Asit Biswas, John Devapriam, Regi Tharian Alexander, Satheesh Kumar,
Hayley Andrews and Samuel Joseph Tromans
Dr Reza Kiani, Dr Asit Biswas
and Dr John Devapriam are
Consultants, all at the
Department of Psychiatry of
Intellectual Disability, Leicester
Frith Hospital, Leicestershire
Partnership NHS Trust,
Leicester, UK.
Dr Regi Tharian Alexander is
Consultant at the Department
of Psychiatry of Intellectual
Disability, St Johns House
Hospital, Partnerships in Care,
Norfolk, UK.
Dr Satheesh Kumar is Consultant
at the Department of Psychiatry
of Intellectual Disability, Leicester
Frith Hospital, Leicestershire
Partnership NHS Trust,
Leicester, UK.
Dr Hayley Andrews is Specialist
Registrar at the Department of
General Adult Psychiatry,
Bradgate Mental Health Unit,
Leicestershire Partnership NHS
Trust, Leicester, UK.
Dr Samuel Joseph Tromans is
Core Trainee (CT2) in
Psychiatry at the Department of
Psychiatry of Intellectual
Disability, Leicester Frith
Hospital, Leicestershire
Partnership NHS Trust,
Leicester, UK.
Abstract
Purpose –Clozapineis a well-known antipsychoticmedication licensed for treatment-resistantschizophrenia,
but there is limited research available to suggest its efficacy in the context of personality disorder and
intellectual disabilities presenting with high-risk behaviour with or without psychotic symptoms. The
purpose of this paper is to raise awareness of the benefits of using clozapine in patients with intellectual
disabilities and personality disorder that presentwith a complex picture of serious risk of harm to both their
life and the lives of others.
Design/methodology/approach –The authors present five patients with intellectual disabilities and serious
life-threatening challenging behaviour whom were started on clozapine as part of their multidisciplinary
treatment plan to manage their presentation. The authors completed baseline assessment of five main
symptom domains and then repeated this assessment following treatment with clozapine.
Findings –In all five cases use of clozapine was objectively associated with an improvement in
symptomatology, quality of life and a safe transfer to the community.
Originality/value –The findings suggest that judicious use of clozapine could be considered as one of
the effective pharmacological strategies in the management of patients with intellectual disabilities and
personality disorder who present with serious life-threatening challenging behaviours.
Keywords Intellectual disability, Self-harm, Antisocial, Borderline personality disorder, Clozapine,
Suicide risk
Paper type Case study
Introduction
While it is generally recognised that the treatment of both borderline and dissocial personality
disorder (BPD and DP D) is predominantly psychologic al, targeted drug treatment of indi vidual
symptoms may be helpful for some patients (Cloninger, 1998). Over recent years, there have
been several randomised controlled trials evaluating the use of psychotropic medication in
personality disorder, but none to date with clozapine (Goldberg et al., 1986; Bogenschutz and
George, 2004). These trials of drug treatment are in comparison at least as good as those of
other interventio ns, although the tr eatments have seld om persisted beyond a few weeks
(Tyrer and Bateman, 2004).
In people with intellectual disabilities intellectual disabilities the diagnosis of BPD or DPD is
carefully made due to the possibility of diagnostic overshadowing between personality
characteristics, intellectual ability, autism, mental illness and/or challenging behaviour (Royal
College of Psychiatrists, 2001). The diagnosis of personality disorders in people with intellectual
disabilities can sometimes be contentious and in routine clinical practice is limited to those
with mild and borderline intellectual disabilities. In the UK, the rate of personality disorders is
around 7 per cent for patients in contact with community intellectual disabilities teams and
Received 15 February 2015
Revised 10 July 2015
Accepted 11 August 2015
The authors are grateful to both
the patients and their families who
gave them permission for the
publication of this manuscript.
DOI 10.1108/AMHID-02-2015-0009 VOL. 9 NO. 6 2015, pp.363-370, ©Emerald Group Publishing Limited, ISSN 2044-1282
j
ADVANCESIN MENTAL HEALTH AND INTELLECTUAL DISABILITIES
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