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Psychiatry
Effective and safe use of intramuscular clozapine in a patient presenting with catatonia and thrombocytopenia
  1. Suresh Thapaliya1,
  2. Eromona Whiskey1,2 and
  3. Mudasir Firdosi1,3
  1. 1Kent and Medway NHS and Social Care Partnership Trust, Maidstone, UK
  2. 2King's College London Institute of Pharmaceutical Science, London, UK
  3. 3Psychiatry, Kent and Medway Medical School, Canterbury, UK
  1. Correspondence to Dr Mudasir Firdosi; mudasirfirdosi{at}gmail.com

Abstract

Clozapine is the most effective medication for the management of treatment-resistant schizophrenia and schizoaffective disorder, and its discontinuation can pose significant challenges in treatment. We present a patient with a diagnosis of schizoaffective disorder who was stable on clozapine for a decade until discontinuation due to thrombocytopenia. She experienced a relapse of her illness, presenting with psychotic and catatonic features with poor oral intake and physical health complications requiring a lengthy admission to the hospital. There was a poor response to alternative antipsychotics and a full course of electroconvulsive therapy. Intramuscular (IM) clozapine was initiated due to catatonia and refusal to accept oral medications. After receiving 10 doses of IM clozapine, she started accepting oral clozapine and made a full recovery within a few weeks. The low platelet count was persistent, and a bone marrow biopsy showed results consistent with immune thrombocytopenia being the cause of that low platelet count.

  • Haematology (drugs and medicines)
  • Psychiatry (drugs and medicines)
  • Ethics
  • Haematology (incl blood transfusion)
  • Immunology

https://doi.org/10.1136/bcr-2024-260197

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    Footnotes

    • X @drmfirdosi

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content: ST, EW and MF. The following authors gave final approval of the manuscript: ST, EW and MF.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.