Clozapine for the treatment-resistant symptoms of derealisation and obsessive ruminations – A clinical case report

Due to its unique pharmacological and clinical profile, clozapine is very important in the treatment of drug-resistant patients with schizophrenia. Beside the known risks of severe leukopenia and agranulocytosis, proconvulsant effects, anticholinergic side effects, orthostatic hypotension, weight gain as well as sedation, the induction or increase of obsessive-compulsive symptoms have been described in psychiatric literature. This case report presents a 21-year old man with a predescribed and remitted obsessive-compulsive disorder. After a single consumption of cannabis, he reports severe and drug-resistant symptoms of derealisation and obsessive ruminations which last for a long period. Results: Several psychopharmacological treatments with selective serotonin reuptake inhibitors, first-generation and second-generation antipsychotic drugs were without response. Only the combined treatment with clomipramine and clozapine led to a complete remission. During the therapy with clomipramine and clozapine, a stability in psychopathological symptoms could be observed at the 1-year catamnesis as well as after the reduction and termination of the medication. Conclusions: Although a single case report cannot prove the efficiency of clozapine in the treatment of drug-resistant symptoms of derealisation and obsessive ruminations, it did show a definitely positive influence without severe side effects. An exazerbation of the predescribed obsessive-compulsive disorder was not observed.

The authors report no financial relationships with commercial interests.