Abstract

Successful Treatment of a Treatment Refractory Patient with Clozapine Retrial

Author(s): Kulwant Buttar, Jeffery J Grace and Eileen Trigoboff

This case study presents a paradigm for a clozapine retrial to treat and help a seriously ill treatment-resistant psychiatric patient, particularly in the context of rare genetic disorders. This patient’s bizarre behavior included sustained and remarkable retropulsion, disrobing, unprovoked striking out at others, urinating and defecating in inappropriate places, mutism, and lying on the floor of the hallway for extended periods of time. Multiple diagnoses as well as varied and extensive genetic and psychopharmacological treatment resulted in an interrupted clozapine induction trial producing the only improvement. That incomplete trial had to be discontinued due to leukopenia. The case is particularly noteworthy for its comprehensive diagnostic workup, leading to the identification of a novel PDGFRB gene mutation associated with Primary Familial Brain Calcification (PFBC). The main finding for this case was a thorough and complete clozapine retrial that brought significant improvement. The principle conclusions of this case highlights the value of genetic testing, the importance of human connection and durable compassionate care, and a re-challenge of clozapine treatment.

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