There is limited evidence relating to the treatment of psychotic symptoms in Huntington's disease (HP); therefore, treatment decisions are based on clinical consensus and expert opinion. In this article, Dr Majothi et al. describe the use of clozapine in an unlicensed manner in HP, which proved to be safe and effective.

There is a considerable paucity of empirical data on the use of clozapine in people with intellectual disability, and to the authors’ knowledge these are the first published data on its use in a patient with trisomy 5p and with a diagnosis of schizophrenia. In this case we describe a patient with learning difficulties and a diagnosis of trisomy 5p and schizophrenia that has responded remarkably to clozapine treatment despite numerous additional clinical risk factors.