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Synergetic effect of electroconvulsive therapy and clozapine therapy in treating severe intractable aggressive behaviour in an adult with intellectual disability: a case report / Wei Da Son, Muhammad Adib Baharom and Suthahar Ariaratnam

There is scarce literature on the use of either clozapine or Electroconvulsive therapy (ECT) and/or their combination in patients having intellectual disability with aggression. To the best of our knowledge, we report the first case of combination use of ECT and clozapine in treating severe intracta...

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Main Authors: Son, Wei Da, Baharom, Muhammad Adib, Ariaratnam, Suthahar
Format: Article
Language:English
Published: Faculty of Medicine 2024
Subjects:
Psychiatry
Online Access:https://ir.uitm.edu.my/id/eprint/91713/1/91713.pdf
https://ir.uitm.edu.my/id/eprint/91713/
http://jchs-medicine.uitm.edu.my/
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spelling my.uitm.ir.917132024-03-05T02:34:24Z https://ir.uitm.edu.my/id/eprint/91713/ Synergetic effect of electroconvulsive therapy and clozapine therapy in treating severe intractable aggressive behaviour in an adult with intellectual disability: a case report / Wei Da Son, Muhammad Adib Baharom and Suthahar Ariaratnam jchs Son, Wei Da Baharom, Muhammad Adib Ariaratnam, Suthahar Psychiatry There is scarce literature on the use of either clozapine or Electroconvulsive therapy (ECT) and/or their combination in patients having intellectual disability with aggression. To the best of our knowledge, we report the first case of combination use of ECT and clozapine in treating severe intractable aggressive behaviour in a 19-year-old male of Chinese descent with severe intellectual disability. Patient presented with disturbed sleep pattern, self-injurious, and severe aggressive behaviour soon after the announcement of Movement Control Order (MCO) by the government of Malaysia sometime in March 2020 as preventive measure to contain COVID19 spread. Consequently, patient’s daily routine was affected, and he had to stay home. Psychosocial interventions were attempted by family members. However, the challenging behaviour persisted for 3 months which led to caregiver burnout and subsequent admission. During the hospitalisation, occupational therapy was initiated, and medication treatment was optimised. Blood parameters investigation was unremarkable. The aggressive behaviours were assessed using modified overt aggression scale (MOAS) and brief psychiatry rating scale (BPRS). There was no satisfactory improvement noted despite being on three secondgeneration antipsychotics (Olanzapine, Quetiapine and Amisulpride). Later, concurrent use of clozapine and ECT were initiated. Patient’s improvement was satisfactory, and he was discharged with Clozapine at 200mg daily as well as after completing 14 sessions of bitemporal ECT (Thymatron system IV, Illinois, USA), thrice a week with 0.5 millisecond pulse width, 70Hz and titration between 25-508 milliCoulombs (mC). The combination use of ECT with clozapine appeared to have a both synergetic and efficacious effects in treating intellectual disability with aggressive behaviours. Faculty of Medicine 2024-03 Article PeerReviewed text en https://ir.uitm.edu.my/id/eprint/91713/1/91713.pdf Synergetic effect of electroconvulsive therapy and clozapine therapy in treating severe intractable aggressive behaviour in an adult with intellectual disability: a case report / Wei Da Son, Muhammad Adib Baharom and Suthahar Ariaratnam. (2024) Journal of Clinical and Health Sciences (JCHS) <https://ir.uitm.edu.my/view/publication/Journal_of_Clinical_and_Health_Sciences_=28JCHS=29/>, 9 (1). pp. 61-66. ISSN 0127-984X http://jchs-medicine.uitm.edu.my/
institution Universiti Teknologi Mara
building Tun Abdul Razak Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Teknologi Mara
content_source UiTM Institutional Repository
url_provider http://ir.uitm.edu.my/
language English
topic Psychiatry
spellingShingle Psychiatry
Son, Wei Da
Baharom, Muhammad Adib
Ariaratnam, Suthahar
Synergetic effect of electroconvulsive therapy and clozapine therapy in treating severe intractable aggressive behaviour in an adult with intellectual disability: a case report / Wei Da Son, Muhammad Adib Baharom and Suthahar Ariaratnam
description There is scarce literature on the use of either clozapine or Electroconvulsive therapy (ECT) and/or their combination in patients having intellectual disability with aggression. To the best of our knowledge, we report the first case of combination use of ECT and clozapine in treating severe intractable aggressive behaviour in a 19-year-old male of Chinese descent with severe intellectual disability. Patient presented with disturbed sleep pattern, self-injurious, and severe aggressive behaviour soon after the announcement of Movement Control Order (MCO) by the government of Malaysia sometime in March 2020 as preventive measure to contain COVID19 spread. Consequently, patient’s daily routine was affected, and he had to stay home. Psychosocial interventions were attempted by family members. However, the challenging behaviour persisted for 3 months which led to caregiver burnout and subsequent admission. During the hospitalisation, occupational therapy was initiated, and medication treatment was optimised. Blood parameters investigation was unremarkable. The aggressive behaviours were assessed using modified overt aggression scale (MOAS) and brief psychiatry rating scale (BPRS). There was no satisfactory improvement noted despite being on three secondgeneration antipsychotics (Olanzapine, Quetiapine and Amisulpride). Later, concurrent use of clozapine and ECT were initiated. Patient’s improvement was satisfactory, and he was discharged with Clozapine at 200mg daily as well as after completing 14 sessions of bitemporal ECT (Thymatron system IV, Illinois, USA), thrice a week with 0.5 millisecond pulse width, 70Hz and titration between 25-508 milliCoulombs (mC). The combination use of ECT with clozapine appeared to have a both synergetic and efficacious effects in treating intellectual disability with aggressive behaviours.
format Article
author Son, Wei Da
Baharom, Muhammad Adib
Ariaratnam, Suthahar
author_facet Son, Wei Da
Baharom, Muhammad Adib
Ariaratnam, Suthahar
author_sort Son, Wei Da
title Synergetic effect of electroconvulsive therapy and clozapine therapy in treating severe intractable aggressive behaviour in an adult with intellectual disability: a case report / Wei Da Son, Muhammad Adib Baharom and Suthahar Ariaratnam
title_short Synergetic effect of electroconvulsive therapy and clozapine therapy in treating severe intractable aggressive behaviour in an adult with intellectual disability: a case report / Wei Da Son, Muhammad Adib Baharom and Suthahar Ariaratnam
title_full Synergetic effect of electroconvulsive therapy and clozapine therapy in treating severe intractable aggressive behaviour in an adult with intellectual disability: a case report / Wei Da Son, Muhammad Adib Baharom and Suthahar Ariaratnam
title_fullStr Synergetic effect of electroconvulsive therapy and clozapine therapy in treating severe intractable aggressive behaviour in an adult with intellectual disability: a case report / Wei Da Son, Muhammad Adib Baharom and Suthahar Ariaratnam
title_full_unstemmed Synergetic effect of electroconvulsive therapy and clozapine therapy in treating severe intractable aggressive behaviour in an adult with intellectual disability: a case report / Wei Da Son, Muhammad Adib Baharom and Suthahar Ariaratnam
title_sort synergetic effect of electroconvulsive therapy and clozapine therapy in treating severe intractable aggressive behaviour in an adult with intellectual disability: a case report / wei da son, muhammad adib baharom and suthahar ariaratnam
publisher Faculty of Medicine
publishDate 2024
url https://ir.uitm.edu.my/id/eprint/91713/1/91713.pdf
https://ir.uitm.edu.my/id/eprint/91713/
http://jchs-medicine.uitm.edu.my/
_version_ 1793161909187379200
score 13.211869

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