Psych CASC / OSCE · Psychopharmacology — clozapine
Explaining clozapine and monitoring to a family (CASC)
CASC-style communication station: shared decision on clozapine after two failed trials, monitoring plan, red flags, and balanced risk–benefit including suicide and response evidence.
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Station instructions (candidate)
You have 7 minutes. Explain why clozapine is being offered after two failed adequate antipsychotic trials, what monitoring means in plain language, and which symptoms should trigger urgent contact. Balance risks (blood counts, heart inflammation early on, severe constipation) against benefits (best evidence in true treatment resistance; suicide-risk advantage in high-risk schizophrenia). Do not guarantee cure. Do not dismiss fears. Do not invent exact national blood cut-offs as universal rules — explain principles and that local protocols apply.[1][2][3]
References5ShowHide
- [1]Howes OD, McCutcheon R, Agid O, et al. Treatment-Resistant Schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology Am J Psychiatry, 2017.PMID 27919182
- [2]Siskind D, Siskind V, Kisely S Clozapine Response Rates among People with Treatment-Resistant Schizophrenia: Data from a Systematic Review and Meta-Analysis Can J Psychiatry, 2017.PMID 28655284
- [3]Meltzer HY, Alphs L, Green AI, et al. Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT) Arch Gen Psychiatry, 2003.PMID 12511175
- [4]Ronaldson KJ, Taylor AJ, Fitzgerald PB, et al. Diagnostic characteristics of clozapine-induced myocarditis identified by an analysis of 38 cases and 47 controls. J Clin Psychiatry, 2010.PMID 20361910
- [5]Palmer SE, McLean RM, Ellis PM, et al. Life-threatening clozapine-induced gastrointestinal hypomotility: an analysis of 102 cases. J Clin Psychiatry, 2008.PMID 18452342