RT Journal Article
SR Electronic
T1 Clozapine Reduces Self-Injurious Behavior in a State Prison Population
JF Journal of the American Academy of Psychiatry and the Law Online
JO J Am Acad Psychiatry Law
FD American Academy of Psychiatry and the Law
SP 61
OP 67
DO 10.29158/JAAPL.003818-19
VO 47
IS 1
A1 Theodore R. Zarzar
A1 Terri L. Catlett
A1 Maria G. O'Connell
A1 Bryan H. Harrelson
A1 Vincent P. Wilson
A1 Genell N. Rashad
A1 Dustin B. Morris
A1 Joseph B. Williams
A1 Susan S. Peebles
A1 Brian B. Sheitman
YR 2019
UL http://jaapl.org/content/47/1/61.abstract
AB Self-injurious behavior (SIB) is a common, disruptive, and costly occurrence in U.S. prisons. In this study, we describe the use of clozapine to treat 10 offenders with chronic, repetitive self-injury refractory to other medications and behavioral therapies. The primary diagnosis for all 10 offenders was a personality disorder. Eight of the 10 inmates allowed weekly blood draws and took medication regularly (approximately 95% adherence), whereas two inmates discontinued treatment within the first two weeks. For these eight patients, we compared the number of in-house urgent care visits and outside emergency room visits related to SIB for the six-month periods before and after treatment with clozapine. After initiation of clozapine treatment, there were 66 fewer urgent care visits (94 versus 28) and 26 fewer emergency room visits (37 versus 11), a 70 percent reduction in each. As a secondary outcome, we assessed disciplinary infractions. There were 132 fewer infractions (197 versus 65), a 67 percent reduction. The median dose of clozapine used was 125 mg/day, substantially lower than doses typically used to treat schizophrenia. Clozapine appears to be a feasible and effective treatment for some patients with chronic, repetitive SIB for whom other treatments have failed.