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CASE REPORT
Successful management of persistent distressing neuropsychiatric symptoms by clozapine in a patient suffering from dementia with Lewy bodies
  1. Manraj Bhamra1,2,
  2. Anto P Rajkumar1,2,
  3. Dominic H Ffytche1,2,
  4. Chris Kalafatis1,2
  1. 1Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK
  2. 2Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, London, UK
  1. Correspondence to Dr Manraj Bhamra, manraj.bhamra{at}slam.nhs.uk

Summary

Dementia with Lewy bodies (DLB) is the second most common neurodegenerative dementia associated with poor prognosis and high carers’ burden. Neuropsychiatric symptoms worsen this prognosis and are a high source of distress for service users and their carers. However, there is currently insufficient evidence to support the pharmacological and non-pharmacological management of these symptoms. Acetylcholinesterase inhibitors are the first-line pharmacological option, but challenging risky behaviours may persist despite their use. Antipsychotic medications are indicated in such clinical scenarios, but there is very limited evidence to support the efficacy and safety of these medications for managing neuropsychiatric symptoms in DLB. Hence, we report an individual with DLB with severe distressing persistent visual hallucinations and agitation. After multiple treatment options had failed, clozapine was successfully initiated with substantial improvement in both clinical and functional outcomes. Further studies are warranted for evaluating the efficacy of clozapine in managing neuropsychiatric symptoms in DLB.

  • psychiatry (drugs and medicines)
  • memory disorders
  • drugs: psychiatry
  • memory disorders (psychiatry)
  • psychiatry of old age
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Footnotes

  • Contributors MB and APR: planning, conduct, reporting, draft and revision of work, conception and design, acquisition of data, analysis and interpretation of data, final approval of the version published and agreement to be accountable for all aspects of the work. DHF: specialist input, reporting, draft and revision of work, conception and design, acquisition of data, analysis and interpretation of data, final approval of the version published and agreement to be accountable for all aspects of the work. CK: responsible clinician, planning, conduct, reporting, draft and revision of work, conception and design, final approval of the version published and agreement to be accountable for all aspects of the work.

  • 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.

  • Competing interests None declared.

  • Patient consent Next of kin consent obtained.

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

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