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She experienced a relapse of her illness, presenting with psychotic and catatonic features with poor oral intake and physical health complications requiring a lengthy admission to the hospital. There was a poor response to alternative antipsychotics and a full course of electroconvulsive therapy. Intramuscular (IM) clozapine was initiated due to catatonia and refusal to accept oral medications. After receiving 10 doses of IM clozapine, she started accepting oral clozapine and made a full recovery within a few weeks. The low platelet count was persistent, and a bone marrow biopsy showed results consistent with immune thrombocytopenia being the cause of that low platelet count.<\/jats:p>","DOI":"10.1136\/bcr-2024-260197","type":"journal-article","created":{"date-parts":[[2024,8,14]],"date-time":"2024-08-14T21:25:18Z","timestamp":1723670718000},"page":"e260197","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Effective and safe use of intramuscular clozapine in a patient presenting with catatonia and thrombocytopenia"],"prefix":"10.1136","volume":"17","author":[{"given":"Suresh","family":"Thapaliya","sequence":"first","affiliation":[{"name":"Kent and Medway NHS and Social Care Partnership Trust, Maidstone, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eromona","family":"Whiskey","sequence":"additional","affiliation":[{"name":"Kent and Medway NHS and Social Care Partnership Trust, Maidstone, UK"},{"name":"King's College London Institute of Pharmaceutical Science, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8450-6484","authenticated-orcid":false,"given":"Mudasir","family":"Firdosi","sequence":"additional","affiliation":[{"name":"Kent and Medway NHS and Social Care Partnership Trust, Maidstone, UK"},{"name":"Psychiatry, Kent and Medway Medical School, Canterbury, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,8,14]]},"reference":[{"key":"2025082804051084000_17.8.e260197.1","doi-asserted-by":"publisher","DOI":"10.1185\/03007999709113338"},{"key":"2025082804051084000_17.8.e260197.2","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.rpsm.2020.05.003","article-title":"Clozapine in patients with schizoaffective disorder: A systematic review","volume":"14","author":"Rey Souto","year":"2021","journal-title":"Rev Psiquiatr Salud Ment (Engl Ed)"},{"key":"2025082804051084000_17.8.e260197.3","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1093\/schbul\/sbab103","article-title":"Reducing the Risk of Withdrawal Symptoms and Relapse Following Clozapine Discontinuation-Is It Feasible to Develop Evidence-Based Guidelines?","volume":"48","author":"Blackman","year":"2022","journal-title":"Schizophr Bull"},{"key":"2025082804051084000_17.8.e260197.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2016.05.002"},{"key":"2025082804051084000_17.8.e260197.5","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1111\/acps.12233","article-title":"Discontinuation of clozapine: a 15-year naturalistic retrospective study of 320 patients","volume":"130","author":"Davis","year":"2014","journal-title":"Acta Psychiatr Scand"},{"key":"2025082804051084000_17.8.e260197.6","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1192\/bjp.2021.36","article-title":"Should intramuscular clozapine be adopted into mainstream clinical practice?","volume":"219","author":"Bhattacherjee","year":"2021","journal-title":"Br J Psychiatry"},{"key":"2025082804051084000_17.8.e260197.7","article-title":"Clozapine and Thrombocytopenia: Case Report & Literature Review","volume":"64","author":"Rakesh","year":"2022","journal-title":"Ind J Psychiatry"},{"key":"2025082804051084000_17.8.e260197.8","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1097\/00007611-199310000-00021","article-title":"Platelet dysfunction associated with clozapine therapy","volume":"86","author":"Durst","year":"1993","journal-title":"South Med J"},{"key":"2025082804051084000_17.8.e260197.9","doi-asserted-by":"crossref","first-page":"149","DOI":"10.4103\/0976-500X.110913","article-title":"Clozapine associated thrombocytopenia","volume":"4","author":"Kate","year":"2013","journal-title":"J Pharmacol Pharmacother"},{"key":"2025082804051084000_17.8.e260197.10","first-page":"233","article-title":"Blood dyscrasias in clozapine-treated patients in Italy","volume":"85","author":"Lambertenghi Deliliers","year":"2000","journal-title":"Haematologica"},{"key":"2025082804051084000_17.8.e260197.11","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1097\/YIC.0000000000000258","article-title":"Need to bleed? Clozapine haematological monitoring approaches a time for change","volume":"34","author":"Whiskey","year":"2019","journal-title":"Int Clin Psychopharmacol"},{"key":"2025082804051084000_17.8.e260197.12","first-page":"10","article-title":"Overcoming Obstacles to Clozapine Treatment: A Case of Clozapine Rechallenge in ECT-Resistant Schizophrenia With Catatonic Features","volume":"28","author":"Dima","year":"2022","journal-title":"J Clin Psychopharmacol"},{"key":"2025082804051084000_17.8.e260197.13","article-title":"Clinical Experience With Intramuscular Clozapine","volume":"13","author":"Munzar","year":"2021","journal-title":"Cureus"},{"key":"2025082804051084000_17.8.e260197.14","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1192\/bjb.2020.6","article-title":"Evaluation of the effectiveness and acceptability of intramuscular clozapine injection: illustrative case series","volume":"44","author":"Henry","year":"2020","journal-title":"BJPsych Bull"},{"key":"2025082804051084000_17.8.e260197.15","doi-asserted-by":"crossref","DOI":"10.1177\/2050313X211004796","article-title":"Intramuscular clozapine in the acute medical hospital: Experiences from a liaison psychiatry team","volume":"9","author":"Gee","year":"2021","journal-title":"SAGE Open Med Case Rep"},{"key":"2025082804051084000_17.8.e260197.16","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2020.115"},{"key":"2025082804051084000_17.8.e260197.17","doi-asserted-by":"publisher","DOI":"10.1111\/acps.13280"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-260197","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T11:05:18Z","timestamp":1756379118000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-260197"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8]]},"references-count":17,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,8,14]]},"published-print":{"date-parts":[[2024,8]]}},"alternative-id":["10.1136\/bcr-2024-260197"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-260197","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8]]}}}