This article describes a case of Venous Thromboembolism (VTE), was developed in a patient with treatment-resistant schizophrenia. Patient was a 35 years-old female with treatment resistant schizophrenia who was tolerating her residual symptoms of perceptual disturbances. Despite good adherence towards treatment, she never had a complete symptom-free period. Patient also attempted suicide by trying to drown herself at a nearby beach. Considering the suicidal risk and persistency of her psychosis, patient was then initiated on Clozapine therapy. Over a period of 8 weeks, gradual dose increment resulted in an improvement of her symptoms where she was reported to have less frequency of perceptual disturbances. She was reviewed weekly for both her response and tolerability towards the Clozapine treatment. Entering the 11th week of her Clozapine therapy, Patient was admitted into the hospital for left leg tenderness in which she was later treated to be having deep vein thrombosis (DVT). Ultrasound finding revealed long segment thrombus seen from external iliac vein down to popliteal vein of her left lower limb. Patient’s medication dose was maintained at the same dose up until the 16th week of her Clozapine therapy. There were no recurrences or reports of side effects and improvement of sleep patterns were reported by her but her psychotic symptoms still persists. There are always risks and benefits while treating a patient with Clozapine. Clinician should be aware of the risk of deep vein thrombosis (DVT) among treatment resistant schizophrenia patient.
Clozapine is effective in treatment resistant schizophrenia. Priaprism is a rare side effect of Clozapine. It is a urological emergency and can lead to permanent damage to the penis. We present two cases two cases of clozapine induced priapism. Both patients were started on Clozapine in view of treatment resistant. For the first patient, priapism was noted after 2 years on Clozapine and treated conservatively. Clozapine was rechallenged in this patient but in a lower dosage and was augmented with amisulpride. He did not develop priaprism until date. In the second case, patient developed priaprism after 7 months on clozapine and required urological intervention. He redeveloped recurrent episode of priaprism as clozapine was restarted on the previous dose. In conclusion, priaprism is not related to dosage or duration of treatment of Clozapine. Thus, a careful risk-benefit assessment need to done as there is always a risk of priapism to recur when clozapine rechallenged.