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Prader-Willi syndrome advice Nurse Lynn

Ask Nurse Lynn: Treatment-Resistant Psychosis and Clozapine

Question:

Male, 18 years old, UPD subtype

My son struggles with psychosis/schizophrenia for 1.5 yrs. None of the antipsychotics applied reduced the symptoms. He is in a miserable situation. The doctors want to use Clozapine as last resource. Is this a drug used frequently in people with PWS and psychosis? Do you have any suggestions or comments? I am so worried as I know that this drug may have severe side-effects. However, my son needs help, and I will do what the doctors recommend. I should note that the psychiatrist who suggested this drug is specialized in PWS. He is in Germany. I just wanted to get an opinion from the US. Thank you so much. 

Nurse Lynn’s Response:

You’re absolutely right: Clozapine is a serious medication, typically reserved for cases where other antipsychotics haven’t worked — a situation known as treatment-resistant psychosis. It is sometimes used in individuals with Prader-Willi Syndrome (PWS) and psychosis, but always with extra caution. The fact that you’re researching, asking questions, and carefully weighing the options means you’re already on the right track.

  • 1. Clozapine is not typically a first-line treatment, but it can be life-changing. Clozapine is sometimes the most effective option for difficult-to-treat psychosis — even in people with PWS. For some, it’s the only medication that truly helps.
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  • 2. Specific concerns in Prader-Willi Syndrome: People with PWS can be more vulnerable to certain side effects, so careful monitoring is essential:
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    1. *Metabolic risks (e.g., weight gain, insulin resistance, blood sugar issues) may be heightened, and Clozapine can exacerbate those.

    2. *Other risks to watch closely for include excessive sedation, seizures, and constipation.

    3. *Despite these risks, when psychosis severely affects quality of life, many experts believe Clozapine is worth considering — but always with close supervision and a tailored approach.

3. Clozapine is used in PWS in the U.S. too — with expert oversight. Although it’s not a standard first choice, specialists in the U.S. do prescribe Clozapine to select patients with PWS and psychosis when other treatments have failed. It sounds like you have access to similar expertise in Germany, which is crucial.

4. Monitoring is critical to safety and success: Starting Clozapine involves strict protocols — and for good reason:

  1. *Weekly blood tests at the beginning to catch rare but serious side effects like agranulocytosis (a drop in white blood cells).

  2. *Regular monitoring of heart function, liver enzymes, and metabolic markers.

  3. *Watching for signs of infection, extreme tiredness, GI issues, or unusual behaviors

Your son’s journey — 1.5 years of psychosis without relief — is deeply painful. Watching someone you love suffer through that, especially without answers, is exhausting and heartbreaking. If other medications haven’t helped, Clozapine may truly be his best chance at regaining stability and quality of life.

Some families describe Clozapine as a turning point after long months (or years) of struggle. Others have to stop it due to side effects — but even then, many feel reassured knowing they gave every option a chance.

A Few Suggestions:

  • 1. Comprehensive pre-assessment: Make sure your son’s cardiac, metabolic, and seizure risk factors are evaluated beforehand — this helps guide safer use.

  • 2. Slow titration can help: A very gradual increase in dosage may improve tolerability, especially in individuals with PWS who may be more sensitive.

3. Ongoing emotional and behavioral support: Medication is only one piece of the puzzle. Continued support — for your son and for your family — is essential. In some cases, specialized care environments are needed when symptoms are especially severe.

Resources:

There is an “ask a professional” service through IPWSO the International PWS association which you could ask international experts questions. https://ipwso.org/how-we-can-help/ask-a-professional/

Do you have a non-emergency medical question for Nurse Lynn? Submit your question here:

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