Top-Up Clozapine for Risperidone LAI-Related Acute Dystonia and TR Bipolar in an Adolescent with ID- Putting the Cart before the Horse?

Psychopharmacol Bull. 2022 May 31;52(2):161-164.

Abstract

Objectives: Young patients with intellectual disability (ID) have both diagnostic and therapeutic challenges. These include, inter alia, diagnostic overshadowing, diagnostic slippage and heightened vulnerability to adverse drug reactions. These would portent a generally poor prognostication.

Methods: This is a case-study of an adolescent with intellectual disability long-hospitalized for co-morbid treatment-resistant bipolar mood disorder that failed to respond to ECT. Patient partially responded to LAI risperidone with repeated ADRs. Top-up with low-dose clozapine (100 mg/d) was pursued.

Results: Low-dose clozapine top-up complemented therapeutic response (mood lability and paranoia) and strikingly safeguarded effectively against risperidone-related extrapyramidal side effects.

Conclusions: Add-on clozapine remains a viable option, albeit off-label, in young patients with ID and treatment-resistant affective/schizophreniform psychoses. Clozapine has an edge over other agents in the setting of dyskinesias.

Keywords: ECT; EPS; adolescent; bipolar mood disorder; clozapine; intellectual disability; risperidone; treatment-resistance.

MeSH terms

  • Adolescent
  • Antipsychotic Agents* / adverse effects
  • Clozapine* / adverse effects
  • Dystonia* / chemically induced
  • Dystonia* / drug therapy
  • Dystonic Disorders* / chemically induced
  • Dystonic Disorders* / drug therapy
  • Humans
  • Intellectual Disability* / chemically induced
  • Intellectual Disability* / drug therapy
  • Risperidone / adverse effects

Substances

  • Antipsychotic Agents
  • Clozapine
  • Risperidone