Psychiatric Bulletin (2007) 31: 191. doi: 10.1192/pb.31.5.191b
© 2007 The Royal College of Psychiatrists
Laki Kranidiotis, Consultant Psychiatrist
Kidderminster Hospital, Kidderminster DY11 6RJ, email:
Laki.Kranidiotis{at}worcsh-tr.wmids.nhs.uk
Sheila Thomas, Community Psychiatric Nurse
Kidderminster Hospital
We read with interest the report by Lyall et al (Psychiatric
Bulletin, January 2007, 31, 16-18) of speech dysfluency associated
with clozapine and would like to report our experience in a patient we are
treating. Our patient is currently 44 and experienced his initial episode of
psychosis when he was 23. Aged 27 he was diagnosed with schizophrenia and
maintenance typical antipsychotic medication was prescribed, with initial good
effect. However, he continued to have low-grade positive symptoms and the
negative syndrome also became apparent. Over the subsequent 10 years he had
many changes of medication with little positive effect. At the age of 38 he
was commenced on clozapine and his positive symptoms rapidly receded. At a
dose of 200 mg he developed a stutter (he had not had this problem as a
child), but the dose was increased to 350 mg daily because of its overall
positive effect. However, the stutter was so disabling that clozapine
optimisation strategies were employed and the clozapine dose was gradually
reduced. Owing to a lack of local speech therapy services our patient was
referred to a neurologist, who confirmed our findings and supported our
medication strategy. Amisulpride and low-dose benzodiazepines were added and
the dose of clozapine was reduced. The stutter reduced with these changes and
disappeared when the clozapine was stopped. His illness is currently well
controlled and his current prescription is amisulpride 400 mg twice daily with
clonazepam 0.5 mg twice daily.
