The use of clozapine in adults with intellectual disability

Background: There are not many studies on the use of clozapine in patients with intellectual disability (ID). The authors describe a case series of patients treated with clozapine, drawn from a medium secure unit, a low secure assessment and treatment service and a community team in the London region.

Method: A retrospective file-review of patients treated in these three settings during the time period March–June 2002 was performed (n = 24). Information was collected using a semistructured proforma.

Results: Of the 24 patients, 67% had schizophrenia, 17% had schizoaffective disorder and 8% had bipolar disorder. Patients had been unwell for a mean of 6 years and had been tried on a mean of four antipsychotics. The mean maximum dose of clozapine was 488mg. The outcomes on the clinical global impression (CGI) scale showed 29% very much improved, 42% much improved, 21% minimally improved and 8% no change. 54% of the whole sample and 53% of those from the medium secure unit were discharged to homes in the community. The drug had to be stopped in four patients, of which three were because of neutropaenia.

Conclusion: Clozapine appears to be safe and efficacious in many people with ID. Careful monitoring of side-effects is needed during therapy.