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Dementia with Lewy bodies (DLB) is a neurodegenerative disorder characterized by cognitive decline, motor symptoms, and other neuropsychiatric manifestations, including visual hallucinations, delusions and disorganized thought processes that can configure a psychotic episode. Managing psychosis in DLB is challenging due to hypersensitivity to antipsychotics. This case report describes a 72-year-old female patient with DLB who presented with psychosis and Parkinsonian symptoms. Initial management with olanzapine (10 mg) was effective for psychosis but led to motor worsening. The inclusion of levodopa-carbidopa and reduction of olanzapine were not effective in the resolution of symptoms. Transition to clozapine performed and resulted in stabilization of psychotic symptoms and motor symptoms improvement. Initially, the patient presented with severe symptomatic hypotension, that required the tapering off to a very low dose (6.25mg) without severe adverse effects. This report highlights the utility of very-low dose clozapine in managing psychosis in DLB and discusses therapeutic challenges.
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