Recurrent falls while taking clozapine

A 56-year-old man developed frequent falls after starting clozapine for treatment-resistant bipolar disorder. His falls were caused by negative myoclonus (see videos)—a rare adverse effect of clozapine. His movement disorder persisted despite adding antiseizure medication (valproate), and the clozapine had to be reduced rapidly to reduce risk of falls and functional impairment. This case emphasises the importance of a thorough medication review and detailed physical examination in patients with psychiatric disorders who develop falls when taking multiple and complex medications.