Presentation Information
[P-36-02]Effective Management of Severe Aggression and Self-Injurious Behaviours with Clozapine in Adults with Autism Spectrum Disorder and Intellectual Disability
*Hui Xin Jenies Foo, Jiaqian Sun, Sajith Sreedharan Geetha (Institute of Mental Health (Singapore))
Keywords:
Clozapine,Neurodevelopmental Disorders,Aggression,Autism,Intellectual Disabilities
Introduction:
Clozapine, effective in managing aggression in treatment-resistant schizophrenia, has shown promise for severe aggression in Autism Spectrum Disorder (ASD), where pharmacological options are limited. We report two adult cases with ASD and intellectual disability (ID) who showed significant improvement in aggression and self-injurious behaviours (SIB) following clozapine treatment.
Methods:
Two male patients (aged 28 and 32) with ASD and ID were admitted to a specialist unit due to severe aggression and SIB unresponsive to behavioural therapy and psychotropics, including risperidone. Clozapine was initiated with family’s agreement in patient’s best interest. Symptoms were tracked using HoNOS-LD and BPI-S, pre-and post-treatment (4 months).
Results:
The first patient (28yo) was treated with 250mg/day. His HoNOS-LD score dropped from 25 to 17, with reduction in aggression (4 to 2), SIB (4 to 0), and relationship problems (4 to 2). BPI-S scores reported reduction in aggression (29 to 6) and SIB (4 to 1). He no longer required physical restraints, engaged in therapy, and improved family interactions, prompting discharge planning.
The second patient (32yo), received 400mg/day. His HoNOS-LD improved from 32 to 25, with aggression reduced (2 to 1), SIB (3 to 1), and better self-care (3 to 2). BPI-S showed aggression reduced (18 to 11) and SIB resolved completely (7 to 0). He showed enhanced participation in therapeutic sessions and outings.
Both experienced sedation and mild tachycardia, resolved through dose adjustment. Blood monitoring showed no haematological complications.
Discussion:
Clozapine led to marked reductions in both aggression and SIB, alongside functional improvements in therapy participation and social interactions with favourable safety profile observed. These cases underscore clozapine’s potential in ASD, particularly when behavioural and conventional pharmacological interventions fail.
Conclusion:
These findings suggest clozapine may offer significant benefits in select ASD patients. Larger controlled studies are needed to confirm safety, efficacy, and optimal dosing.
Clozapine, effective in managing aggression in treatment-resistant schizophrenia, has shown promise for severe aggression in Autism Spectrum Disorder (ASD), where pharmacological options are limited. We report two adult cases with ASD and intellectual disability (ID) who showed significant improvement in aggression and self-injurious behaviours (SIB) following clozapine treatment.
Methods:
Two male patients (aged 28 and 32) with ASD and ID were admitted to a specialist unit due to severe aggression and SIB unresponsive to behavioural therapy and psychotropics, including risperidone. Clozapine was initiated with family’s agreement in patient’s best interest. Symptoms were tracked using HoNOS-LD and BPI-S, pre-and post-treatment (4 months).
Results:
The first patient (28yo) was treated with 250mg/day. His HoNOS-LD score dropped from 25 to 17, with reduction in aggression (4 to 2), SIB (4 to 0), and relationship problems (4 to 2). BPI-S scores reported reduction in aggression (29 to 6) and SIB (4 to 1). He no longer required physical restraints, engaged in therapy, and improved family interactions, prompting discharge planning.
The second patient (32yo), received 400mg/day. His HoNOS-LD improved from 32 to 25, with aggression reduced (2 to 1), SIB (3 to 1), and better self-care (3 to 2). BPI-S showed aggression reduced (18 to 11) and SIB resolved completely (7 to 0). He showed enhanced participation in therapeutic sessions and outings.
Both experienced sedation and mild tachycardia, resolved through dose adjustment. Blood monitoring showed no haematological complications.
Discussion:
Clozapine led to marked reductions in both aggression and SIB, alongside functional improvements in therapy participation and social interactions with favourable safety profile observed. These cases underscore clozapine’s potential in ASD, particularly when behavioural and conventional pharmacological interventions fail.
Conclusion:
These findings suggest clozapine may offer significant benefits in select ASD patients. Larger controlled studies are needed to confirm safety, efficacy, and optimal dosing.