Successful management of persistent distressing neuropsychiatric symptoms by clozapine in a patient suffering from dementia with Lewy bodies

Bhamra, Manraj; Rajkumar, Anto P.; Ffytche, Dominic; Kalafatis, Chris

doi:10.1136/bcr-2018-224710

Cited by 6 publications

(6 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This agrees with Harwood [37] who asserts that if treated in the wrong way, people with dementia are easily distressed, suffer complications and may be unnecessarily disabled. Also poor response after multiple treatment options in patients with dementia has been reported [38] even with adverse central effects especially when using opioid analgesic drugs [35]. At clinic level, the observed minimal visits to clinics are well understood and expected.…”

Section: Discussionmentioning

confidence: 99%

Exploring pathways to Hospital Care for Patients with Alzheimer’s disease and related dementias in rural South Western Uganda

Kakongi

Rukundo

Gelaye

et al. 2020

BMC Health Serv Res

View full text Add to dashboard Cite

Background: In order to analyze use of health services and identify sources of delays in accessing the right care for patients with Alzheimer's disease and related dementias (AD/ADRD), understanding of care seeking pathways is needed. The objectives of this study were: (i) to explore pathways to hospital care for patients with AD/ADRD and (ii) to describe challenges experienced by the patients and their families while seeking health care. Methods: Using purposive sampling, 30-in-depth, semi-structured interviews were conducted among caregivers of older adults diagnosed with dementia from rural Southwestern, Uganda. Data was analyzed using ATLAS. Ti software. Results: There was variability in pathways to care from individual to individual. There was one broader theme captured: points of care choice with four broader categories: hospitals, clinics, places of religious worship and traditional healers' shrines, each with its facilitating factors, outcomes and challenges encountered. Most of the respondents reported use of hospitals at first and second visit to the health care point but places of religious worship became more common from third to sixth health care encounter. Major improvements (58.1%) were observed on hospital use but little or no help with prayers, clinics and traditional healers. The challenges experienced with formal points of care focused on lack and cost of prescribed drugs, weakening effect of the drugs, lack of skills to manage the condition, and lack of improvement in quality of life. These challenges together with knowledge gap about the disease and belief in spiritual healing facilitated the shift from formal to informal health care pathways, more particularly the places of religious worship.

show abstract

Section: Discussionmentioning

confidence: 99%

Exploring pathways to Hospital Care for Patients with Alzheimer’s disease and related dementias in rural South Western Uganda

Kakongi

Rukundo

Gelaye

et al. 2020

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…As for reports on the use of clozapine in single cases of dementia, one 19 reports a schizophrenic patient with Korsakoff syndrome who could be discharged from a closed ward 4 weeks after starting clozapine at a higher dosage (450 mg/day), although this case should not be considered a typical dementia patient given the principal diagnosis of schizophrenia. Another report exists of a patient with DLB who was successfully treated with clozapine for hallucinations and agitation 29 . A more typical case is found of a 75‐year‐old demented man who was successfully treated for behavioural problems with clozapine at low doses, 18 twice failing to reduce the dose.…”

Section: Discussionmentioning

confidence: 99%

Clozapine for the treatment of aggressiveness and agitation in advanced dementia

Michael,

Erfurth

et al. 2023

Psychogeriatrics

View full text Add to dashboard Cite

BackgroundDistressing behavioural symptoms, particularly agitation and aggressiveness, remain a difficult problem in everyday clinical practice in the treatment of multimorbid patients with dementia. Clozapine may be an effective therapeutic alternative in this context.MethodsIn a retrospective study, patients who had a diagnosis of dementia and had been treated in a specialized geriatric psychiatry unit with clozapine between August 2018 and February 2022 were included, and medical records were systematically reviewed. The Clinical Global Impressions Scale was used to assess improvement, and the Pittsburgh Agitation Scale for symptom reduction. In addition, side effects and clinical features were documented in detail.ResultsA total of 31 patients (median age 82 years) were identified with a mean clozapine dose of 47.2 (SD 35.6) mg. A total of 13 patients tolerated clozapine very well, 10 showed tolerable side effects, and in 10 patients side effects were the reason for stopping clozapine. Behavioural symptoms improved significantly, as indicated by the assessment scores.ConclusionsIn summary, clozapine was effective and well tolerated in 23 patients, suggesting that low‐dose clozapine may help to alleviate the suffering of difficult‐to‐treat multimorbid patients with advanced dementia and their caregivers. However, particular attention should be paid to adverse drug reactions, especially in patients with cardiovascular and pulmonary impairment.

show abstract

“…In a recent case report, clozapine was initiated as an adjunct to an acetylcholinesterase inhibitor resulting in complete remission of agitation and reduction in psychosis symptoms without impairing mood or behavior symptoms. 25 Valproic acid can be helpful as an adjunct to atypical antipsychotic medications such as quetiapine in managing agitation; however evidence for this is sparse. 26 Studies have shown reduction in concomitant psychoactive medications when valproic acid is used in acutely agitated patients.…”

Section: Discussionmentioning

confidence: 99%

Psychosis Management in Lewy Body Dementia: A Comprehensive Clinical Approach

Badwal

Kiliaki

Dugani

et al. 2021

J Geriatr Psychiatry Neurol

View full text Add to dashboard Cite

Lewy body dementia (LBD) is asynucleinopathy that results in clinical manifestation of motor and neuropsychiatric symptoms. The disease burden associated with psychosis in LBD patients is significantly higher compared to other types of dementia or even to LBD without psychosis. Effective care management processes should include consideration of de-prescribing any offending agents including anticholinergics and dopaminergic agents, followed by nonpharmacological and low risk pharmacological approach. If addition of pharmacological agents is required, consideration should be given to acetylcholinesterase inhibitors, pimavanserin and atypical antipsychotics such as quetiapine or clozapine. Side effects of these medications should be considered prior to selection and initiation of a medication regimen. Goals of care and functional assessment are a crucial part of the optimized care plan, given overall guarded prognosis, in the context of numerous complications observed in this population. Palliative care consultation could facilitate symptom control and timely enrollment into hospice if consistent with patient’s goals.

show abstract

Successful management of persistent distressing neuropsychiatric symptoms by clozapine in a patient suffering from dementia with Lewy bodies

Cited by 6 publications

References 29 publications

Exploring pathways to Hospital Care for Patients with Alzheimer’s disease and related dementias in rural South Western Uganda

Exploring pathways to Hospital Care for Patients with Alzheimer’s disease and related dementias in rural South Western Uganda

Clozapine for the treatment of aggressiveness and agitation in advanced dementia

Psychosis Management in Lewy Body Dementia: A Comprehensive Clinical Approach

Contact Info

Product

Resources

About