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J Am Acad Psychiatry Law. 2019 Mar;47(1):61-67. doi: 10.29158/JAAPL.003818-19. Epub 2019 Feb 19.

Clozapine Reduces Self-Injurious Behavior in a State Prison Population.

Author information

1
Dr. Zarzar is a Clinical Associate Professor, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC. Ms. Catlett is Deputy Director, Health Services, Dr. O'Connell is Director of Mental Health, Dr. Harrelson is Chief of Psychiatry, Dr. Wilson is a family physician, Ms. Rashad is a staff psychologist, and Dr. Morris is Psychological Program Manager at North Carolina Department of Public Safety, Raleigh, NC. Dr. Williams is a Clinical Assistant Professor, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC. Dr. Peebles is Medical Director, North Carolina Division of State Operated Healthcare Facilities, Raleigh, NC. Dr. Sheitman is a Professor, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC. Theodore_zarzar@med.unc.edu.
2
Dr. Zarzar is a Clinical Associate Professor, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC. Ms. Catlett is Deputy Director, Health Services, Dr. O'Connell is Director of Mental Health, Dr. Harrelson is Chief of Psychiatry, Dr. Wilson is a family physician, Ms. Rashad is a staff psychologist, and Dr. Morris is Psychological Program Manager at North Carolina Department of Public Safety, Raleigh, NC. Dr. Williams is a Clinical Assistant Professor, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC. Dr. Peebles is Medical Director, North Carolina Division of State Operated Healthcare Facilities, Raleigh, NC. Dr. Sheitman is a Professor, Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC.

Abstract

Self-injurious behavior (SIB) is a common, disruptive, and costly occurrence in U.S. prisons. In this study, we describe the use of clozapine to treat 10 offenders with chronic, repetitive self-injury refractory to other medications and behavioral therapies. The primary diagnosis for all 10 offenders was a personality disorder. Eight of the 10 inmates allowed weekly blood draws and took medication regularly (approximately 95% adherence), whereas two inmates discontinued treatment within the first two weeks. For these eight patients, we compared the number of in-house urgent care visits and outside emergency room visits related to SIB for the six-month periods before and after treatment with clozapine. After initiation of clozapine treatment, there were 66 fewer urgent care visits (94 versus 28) and 26 fewer emergency room visits (37 versus 11), a 70 percent reduction in each. As a secondary outcome, we assessed disciplinary infractions. There were 132 fewer infractions (197 versus 65), a 67 percent reduction. The median dose of clozapine used was 125 mg/day, substantially lower than doses typically used to treat schizophrenia. Clozapine appears to be a feasible and effective treatment for some patients with chronic, repetitive SIB for whom other treatments have failed.

PMID:
30782606
DOI:
10.29158/JAAPL.003818-19

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