{
  "abstract": "Background Patients with Paranoid Schizophrenia are more likely to develop Fronto Temporal Dementia. Despite existing controversies and increasing evidence favouring non-pharmacological treatments, antipsychotics are still used to mitigate BPSD. Clozapine is a rare treatment choice in patients with dementia. This case report discuses reintroduction of Clozapine in a 74-year-old male with FTD complicated by extreme BPSD developed in the context of a life-long history of Paranoid Schizophrenia previously successfully treated with Clozapine.Case Description A 74-year-old male, retired GP, diagnosed with Frontotemporal Dementia based on progressive deterioration in verbal communication, cognitive impairment, challenging behaviour and cortical atrophy, especially in temporal lobes, evident in MRI, was referred to our hospital due to extreme BPSD in the form of verbal and physical aggression, self-harm, poor food and fluid intake, and sexual disinhibition. The symptoms did not respond to pharmacological (antipsychotics, SSRIs, benzodiazepines, pregabalin) or non-pharmacological approaches (redirection, de-escalation). The onset of BPSD coincided with discontinuation of Clozapine which was successfully facilitating remission of Paranoid Schizophrenia the patient had been suffering from since his early twenties. Clozapine was discontinued two years prior to the referral as presumed no longer required. On admission the patient was extremely agitated with no meaningful verbal contact, refusing food and fluids and unable to bear his weight. Blood tests showed dehydration and AKI which prompted referral to general hospital. On his return, despite improvement in his physical health the patient continued to demonstrate extreme BPSD.Treatment and Outcome Multidisciplinary approach was used to develop and deliver care and treatment using pharmacotherapy along non-pharmacological interventions. As standardized outcome measures, we used CBS, NPI and FIM/FAM. Subsequently to unsuccessful trial of Rivastigmine which caused excessive sweating and salivation with minimal behavioural benefits, Clozapine was gradually reintroduced up to the dose of 200mg/24 hours. We observed improvements in appetite and fluid intake and overall reduction of frequency and intensity of incidents of challenging behaviour. No adverse effects were observed.Conclusion Clozapine, prescribed along a multidisciplinary input, could be a safe choice to mitigate BPSD in patients developing dementia in the context of psychotic disorders which already responded positively to this medication.",
  "authors": [
    {
      "affiliations": [
        "Saint Peter’s Hospital, IRIS CARE GROUP, Llandevaud, Newport NP18 2AA, Wales, UK"
      ],
      "name": "Grzegorz Grzegorzak"
    },
    {
      "affiliations": [
        "Saint Peter’s Hospital, IRIS CARE GROUP, Llandevaud, Newport NP18 2AA, Wales, UK"
      ],
      "name": "Frank Bekomson"
    }
  ],
  "title": "#8198 Reintroduction of clozapine to alleviate extreme BPSD (behavioural and psychological symptoms of dementia) in a patient with Fronto Temporal Dementia developed in the context of life-long history of treatment resistant paranoid schizophrenia previously successfully treated with clozapine",
  "uid": "725048bb-7b43-547d-80d0-0a74ac88efdd"
}