Schizophrenia spectrum — structured clinical viva

This is a relapse of schizophrenia driven by non-adherence, with passive death wishes requiring structured suicide risk assessment (protective factors, intent, plan, means, command content, substance use, hopelessness, support). Acute priorities: safety, re-engagement, restart of antipsychotic (consider LAI if non-adherence is the pattern), medical review, and collaborative crisis planning with his mother as appropriate under privacy law. ^[1]

Whether clozapine is indicated depends on treatment resistance versus non-adherence. If he has never had two adequate adherent trials, he may not yet meet TRRIP resistance criteria — the first task is an adequate adherent trial (often supported by LAI). If he has already failed two adequate trials when adherent, clozapine is the evidence-based next step.^[1]

InterSePT supports clozapine over olanzapine for suicidal behaviour in schizophrenia/schizoaffective disorder — relevant given death wishes, but acute risk management still requires means restriction, follow-up intensity and possible admission.^[2]

Physical health: weight, BMI, glucose, lipids, smoking, ECG; olanzapine’s metabolic burden; long-term mortality driven heavily by cardiovascular disease — FIN11 informs the mortality conversation without ignoring metabolic harm.^[3]