Clozapine with mental retardation

Antonacci DJ, de Groot CM. Clozapine treatment in a population of adults with mental retardation. J Clin Psychiatry 2000 61(l) 22-5. 

Nervous system TD is less commonly associated with SGAs but certain factors may increase risk. A case of an adolescent female with mental retardation and schizophrenia use developing TD with chronic use of olanzapine is reported [168 ]. This patient was subsequently successfully treated with clozapine. Similarly, the presence of Dandy-Walker variant likely predisposed a 20-year-old male to TD which had first developed on FGAs and exacerbated with olanzapine before improving on low-dose aripiprazole [169 ]. A case of a 24-year-old male who developed TD after reinstatement of olanzapine and a course of ECT is reported [170 ]. 

Clozapine has been used in some special groups of patients, including patients with severe borderline personality disorder (8), patients with aggressive schizophrenia (9), and mentally retarded adults (10). 

Patients with aggressive schizophrenia (n = 29) improved when treated with clozapine one was withdrawn after the development of leukopenia. In 10 mentally retarded patients taking clozapine for 15 days to 46 months improvement was observed. Half of the patients developed sedation and hypersalivation, and one discontinued the drug after 2 weeks because of neutropenia. The putative neurotoxicity of clozapine in moderately to... 

The results of a similar study of ours, in which the study drugs were three atypical neuroleptics or antipsychotics, are given in Table 5-4. During the time of this study, clozapine, olanzapine, and risperidone were the only atypical neuroleptic or antipsychotic agents in general use at HCPC these three drugs were selectively used in accordance with the clinical criteria set by the Harris County Mental Health and Mental Retardation Authority. These criteria included documentation of at least two failures to respond clinically to treatment with different typical neuroleptic agents. 

---