Clozapine Reduces Self-Injurious Behavior in a State Prison Population

Area of Science:

• Forensic Psychiatry
• Clinical Psychology
• Pharmacology

Background:

• Self-injurious behavior (SIB) is prevalent and costly in correctional facilities.
• Existing treatments for chronic SIB often prove ineffective.
• Personality disorders are frequently associated with refractory SIB in incarcerated populations.

Purpose of the Study:

• To evaluate the efficacy of clozapine in treating chronic, treatment-refractory SIB among offenders.
• To assess the impact of clozapine on healthcare utilization and disciplinary actions related to SIB.

Main Methods:

• A case series of 10 offenders with personality disorders and chronic SIB was studied.
• Eight participants completed treatment, with outcomes measured by comparing pre- and post-clozapine urgent care and emergency room visits.
• Disciplinary infractions were also recorded as a secondary outcome.

Main Results:

• Clozapine treatment resulted in a 70% reduction in urgent care visits (94 to 28) and emergency room visits (37 to 11) related to SIB.
• Disciplinary infractions decreased by 67% (197 to 65).
• The median effective dose was 125 mg/day, lower than typical doses for schizophrenia.

Conclusions:

• Clozapine is a feasible and effective treatment option for select incarcerated individuals with chronic SIB refractory to other therapies.
• Lower doses of clozapine may be sufficient for managing SIB in this population.
• Further research is warranted to explore clozapine's role in correctional mental health settings.