A 57-year-old female patient with a diagnosis of schizo-affective disorder since 1986 was commenced on clozapine due to persistent positive and negative psychotic symptoms in September 2014. After commencement of clozapine she was delusion free and demonstrated an improvement in negative symptoms. Three months after commencement of clozapine she developed a hypersensitivity reaction. Her symptoms continued to deteriorate despite being prescribed an anti-histamine. Clozapine was discontinued 6 days after the appearance of a generalised pruritic rash, as it was believed to be the probable cause. There was complete resolution of symptoms 1 week after discontinuation of clozapine. Clozapine was replaced with olanzapine and amisulpride. There has been no similar cutaneous or allergic reactions for the past 30 months.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0790966717000453

A clozapine-induced hypersensitivity reaction

Dear Editor, Clozapine is one of the most efficacious treatments in resistant schizophrenia. With action on multiple neurotransmitter systems, clozapine is attributed with multiple common (e.g., sedation, hypersalivation, tachycardia, constipation, weight gain, and seizures) and rare but serious (e.g., agranulocytosis and myocarditis) adverse effects limiting its clinical usage. There are reports of other rarer side-effects such as gastroesophageal reflux disease, priapism, intertriginous erythema, pulmonary thromboembolism, pseudo-pheochromocytoma, and parotitis. Stuttering is one such unusual adverse effect of clozapine. In this case report, we describe a rare adverse effect of stuttering related to clozapine.

https://journals.sagepub.com/doi/pdf/10.4103/IJPSYM.IJPSYM_157_18

“I stopped hearing voices, started to stutter” – A case of clozapine-induced stuttering

Context: Mental health professionals interact with substantial numbers of parents, mainly mothers, who suffer from severe mental disorders and who are treated, acutely or chronically, with antipsychotic medication. The behavior of these clients is affected by their primary illness but also by many other factors, including their drug regimen. The treating team, however, does not always recognize that a drug can profoundly impact cognition and behavior. The aim of this paper is to inform non-medical mental health workers how antipsychotic medication (AP) can influence client cognition and behavior, and thereby impact the safety of the client’s children. Indirectly, APs can also affect the immediate and longer-term behavior of the children.
Evidence Acquisition: This article qualitatively reviews the very sparse literature on antipsychotic effects on cognition and behavior in populations of mentally ill mothers of young children. This narrative review includes case illustrations taken from a clinic for women with psychotic disorders. Also included are references to studies of rodent maternal behavior, as influenced by antipsychotic drugs.
Results: Animal studies have shown that maternal behavior in rodents is impaired by antipsychotic drugs. In humans, drug effects such as sedation, dizziness, indicated thinking, tardive dyskinesia, increased appetite, and sleepwalking, as well as client beliefs about and attitudes toward their drugs, can affect their problem solving, decision-making, and behavior and, thus, play a critical role in child custody determinations. Behavior induced by drugs includes issues of tolerance, withdrawal, and sensitization. Importantly, there are major safety concerns related to APs.
Conclusions: Listening attentively when clients speak about their drugs and understanding potential drug effects help mental health professionals increase their therapeutic efficacy and make sound decisions about clients and their children.

http://womenshealthbulletin.sums.ac.ir/article_45278_62bd3a584482bc6a52071559c9789033.pdf

Assessing the Effects of Antipsychotics on Parenting

Stuttering is a rare side effect of clozapine. It has been shown to occur in the presence of one or more factors such as abnormal electrophysiological findings and seizures, extrapyramidal symptoms, brain pathology, and a family history of stuttering. Few case reports have documented the occurrence of clozapine-induced stuttering in the absence of these risk factors. A 29-year-old African male on clozapine for treatment-resistant schizophrenia presented with stuttering at a dosage of 400 mg/day that resolved with dose reduction. Electroencephalogram findings were normal, and there was no clinical evidence of seizures. The patient had no prior history or family history of stuttering, had a normal neurological examination, and showed no signs of extrapyramidal symptoms. Clinicians ought to be aware of stuttering as a side effect of clozapine, even in the absence of known risk factors. Further research should investigate the pathophysiology of clozapine-induced stuttering.

/pdf/clozapine-induced-stuttering-in-the-absence-of-known-risk-2wj5trvrxh.pdf

Clozapine-induced stuttering in the absence of known risk factors: a case report

Background Treatment-resistant schizophrenia is a severe form of schizophrenia characterized by poor response to at least two antipsychotic drugs and is typically treated with clozapine. However, clozapine lowers the epileptic threshold, leading to seizures, which are severe side effects of antipsychotics that result in multiple complications. Clozapine-related seizures are generally considered to be dose-dependent and especially rare in the low-dose (150-300 mg/d) clozapine treated population. Due to clinical rarity, little is known about its clinical characteristics and treatment. Case summary A 62-year-old Chinese man with a 40-year history of treatment-resistant schizophrenia presented to the Emergency Department with symptoms of myoclonus, consciousness disturbance and vomiting after taking 125 mg clozapine. Upon admission, the patient had a suddenly generalized tonic-clonic seizure lasting for about half a minute with persistent disturbance of consciousness, fever, cough and bloody sputum, which was considered to be low-dose clozapine-related seizure. After antiepileptic and multiple anti-infection treatments, the patient was discharged without epileptic or psychotic symptoms. Conclusion Our aim is to highlight the early prevention and optimal treatment of clozapine-related seizure through case analysis and literature review.

Low-dose clozapine-related seizure: A case report and literature review

Objectives:Clozapine is the most effective treatment available for treatment-resistant schizophrenia; however, it is also associated with a large array of adverse effects that limits its tolerabili...

https://journals.sagepub.com/doi/pdf/10.1177/2045125315590060

Clozapine-induced stuttering: an estimate of prevalence in the west of Ireland

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Clozapine-induced stuttering: an estimate of prevalence in the west of Ireland