Clozapine treatment of psychosis associated with velo-cardio-facial syndrome: benefits and risks

Background Clozapine is licensed for the treatment of psychotic illnesses resistant to other antipsychotic medications. Velo‐cardio‐facial syndrome (VCFS) is associated with a vulnerability to psychotic illness that may be resistant to treatment with conventional typical and atypical antipsychotics. Patients and methods A 32‐year‐old man with intellectual disability (ID) and a long history of treatment‐resistant psychosis was found to have VCFS. Treatment with typical antipsychotic drugs and with one atypical olanzapine produced no improvement. Results Treatment with clozapine produced an improvement in psychotic symptoms and associated behavioural abnormalities, but caused hypersalivation, constipation and a seizure disorder. The latter led to two fractures, one requiring surgery. The addition of sodium valproate stopped seizures. Conclusions Clozapine may improve psychotic symptoms for people with ID associated with VCFS, but clinicians should be alert for potential adverse effects.