title: Clozapine for psychotic disorders in adults with intellectual disabilities.
abstract: BACKGROUND
  Psychosis is three times more common in people with an intellectual disability than in those without an intellectual disability. A low intelligence quotient (IQ) is a defining characteristic for intellectual disability and a risk factor for poor outcome in psychosis. Clozapine is recommended for treatment-resistant psychosis. The effect of psychotropic medication can be different in people with intellectual disability; for example, they may be more prone to side effects. People with an intellectual disability and psychosis form a special subgroup and we wanted to examine if there is randomised controlled trial (RCT) data in this population to support the use of clozapine.
  
  
  OBJECTIVE
  To determine the effects of clozapine for treating adults with a dual diagnosis of intellectual disability and psychosis.
  
  
  METHODS
  We searched CENTRAL, Ovid MEDLINE, Embase and eight other databases up to December 2014. We also searched two trials registers, the Cochrane Schizophrenia Group's Register of Trials, and contacted the manufacturers of clozapine.
  
  
  METHODS
  RCTs that assessed the effects of clozapine, at any dose, for treating adults (aged 18 years and over) with a dual diagnosis of intellectual disability and psychotic disorder, compared with placebo or another antipsychotic medication.
  
  
  METHODS
  Three review authors independently screened all titles, abstracts and any relevant full-text reports against the inclusion criteria.
  
  
  RESULTS
  Of the 1224 titles and abstracts screened, we shortlisted 38 full-text articles, which we subsequently excluded as they did not meet the inclusion criteria. These studies were not RCTs. Consequently, no studies are included in this Cochrane review.
  
  
  CONCLUSIONS
  There are currently no RCTs that assess the efficacy and side effects of clozapine in people with intellectual disabilities and psychoses. Given the use of clozapine in this vulnerable population, there is an urgent need for a RCT of clozapine in people with a dual diagnosis of intellectual disability and psychosis to fill the evidence gap.
authors.affiliation: Department of Psychiatry, Queen's University, 191 Portsmouth Avenue, Kingston, ON, Canada, K7M 8A6.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Ayub
authors.forename: Khalid
authors.initials: K
authors.lastname: Saeed
authors.forename: Tariq A
authors.initials: TA
authors.lastname: Munshi
authors.forename: Farooq
authors.initials: F
authors.lastname: Naeem
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003024:Clozapine / Q000627:therapeutic use*; D006801:Humans; D008607:Intellectual Disability / Q000523:psychology*; D011618:Psychotic Disorders / Q000188:drug therapy*
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine