Skip to main content

Advertisement

Log in

Training in a Clozapine Clinic for Psychiatry Residents: A Plea and Suggestions for Implementation

  • Brief Report
  • Published:
Academic Psychiatry Aims and scope Submit manuscript

Abstract

Objective

The authors sought to develop a model educational clinic and curriculum for psychiatric residents, to increase knowledge and comfort about clozapine prescribing. This matters because clozapine is an important evidence-based treatment for refractory schizophrenia that remains underutilized in clinical practice.

Methods

This is a description of how the Clozapine Clinic of the Massachusetts General Hospital (MGH) Schizophrenia Program was integrated into the curriculum of the MGH-McLean Adult Psychiatric Residency.

Results

PGY-II residents participated in a weekly clozapine clinic with direct patient contact and accompanying curriculum-based instruction for a 6-week period. The method of teaching by participating in a dedicated Clozapine Clinic received favorable feedback. Residents’ knowledge about clozapine increased.

Conclusion

Residency programs should determine whether their trainees receive sufficient training in the use of clozapine and consider setting up clozapine clinics where feasible.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Hill M, Freudenreich O: Clozapine: key discussion points for prescribers. Clin Schizophr Rel Psychoses (in press)

  2. NICE website: http://www.nice.org.uk/CG82; last accessed 02/18/12

  3. Buchanan RW, Kreyenbuhl J, Kelly DL; Schizophrenia Patient Outcomes Research Team (PORT): The 2009 Schizophrenia PORT psychopharmacological treatment recommendations and summary statements. Schizophr Bull 2010; 36:71–93

    Article  PubMed  Google Scholar 

  4. Miller AL, Hall CS, Buchanan RW, et al: The Texas Medication Algorithm Project antipsychotic algorithm for schizophrenia: 2003 update. J Clin Psychiatry 2004; 65:500–508

    Article  PubMed  Google Scholar 

  5. APA: http://www.psychiatryonline.com/pracGuide/pracGuide-Topic_4.aspx; last accessed 02/18/12

  6. Henderson DC, Cagliero E, Gray C, et al: Clozapine, diabetes mellitus, weight gain, and lipid abnormalities: a five-year naturalistic study. Am J Psychiatry 2000; 157:975–981

    Article  CAS  PubMed  Google Scholar 

  7. Honigfeld G, Arellano F, Sethi J, et al: Reducing clozapine-related morbidity and mortality: 5 years of experience with the Clozaril National Registry. J Clin Psychiatry 1998; 59 (Suppl 3):3–7

    PubMed  Google Scholar 

  8. Fayek M, Flowers C, Signorelli D, et al: Psychopharmacology: underuse of evidence-based treatments in psychiatry. Psychiatr Serv 2003; 54:1453–1454, 1456

    Article  PubMed  Google Scholar 

  9. Kane J, Honigfeld G, Singer J, et al: Clozapine for the treatment-resistant schizophrenic: a double-blind comparison with chlorpromazine. Arch Gen Psychiatry 1988; 45:789–796

    Article  CAS  PubMed  Google Scholar 

  10. McEvoy JP, Lieberman JA, Stroup TS; CATIE Investigators: Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment. Am J Psychiatry 2006; 163:600–610

    Article  PubMed  Google Scholar 

  11. Kelly DL, Kreyenbuhl J, Dixon L, et al: Clozapine un-derutilization and discontinuation in African Americans due to leucopenia. Schizophr Bull 2007; 33:1221–1224

    Article  PubMed  Google Scholar 

  12. Mistry H, Osborn D: Underuse of clozapine in treatment-resistant schizophrenia. Adv Psychiatr Treat 2011; 17:250–255

    Article  Google Scholar 

  13. Meltzer HY, Alphs L, Green AI: International Suicide Prevention Trial Study Group: Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT). Arch Gen Psychiatry 2003; 60:82–91

    Article  CAS  PubMed  Google Scholar 

  14. Agid O, Arenovich T, Sajeev G, et al: An algorithm-based approach to first-episode schizophrenia: response rates over 3 prospective antipsychotic trials with a retrospective data analysis. J Clin Psychiatry 2011; 72:1439–1444

    Article  PubMed  Google Scholar 

  15. Lesser CS, Lucey CR, Egener B, et al: A behavioral and systems view of professionalism. JAMA 2010; 304:2732–2737

    Article  CAS  PubMed  Google Scholar 

  16. Munro J, O’Sullivan D, Andrews C, et al: Active monitoring of 12,760 clozapine recipients in the UK and Ireland: beyond pharmaco-vigilance. Br J Psychiatry 1999; 175:576–580

    Article  CAS  PubMed  Google Scholar 

  17. Kilian JG, Kerr K, Lawrence C, et al: Myocarditis and cardio-myopathy associated with clozapine. Lancet 1999; 354:1841–1845

    Article  CAS  PubMed  Google Scholar 

  18. VanderZwaag C, McGee M, McEvoy JP, et al: Response of patients with treatment-refractory schizophrenia to clozapine within three serum level ranges. Am J Psychiatry 1996; 153:1579–1584

    Google Scholar 

  19. Henderson DC, Cagliero E, Copeland PM, et al: Glucose metabolism in patients with schizophrenia treated with atypical antipsychotic agents: a frequently sampled intravenous glucose tolerance test and minimal model analysis. Arch Gen Psychiatry 2005; 62:19–28

    Article  CAS  PubMed  Google Scholar 

  20. Honer WG, Thornton AE, Chen EYH; Clozapine and Risperidone Enhancement (CARE) Study Group: Clozapine alone versus clozapine and risperidone with refractory schizophrenia. N Engl J Med 2006; 354:472–482

    Article  CAS  PubMed  Google Scholar 

  21. Vespa P, Diringer MN; Participants in the International Multi-Disciplinary Consensus Conference on the Critical Care Management of Subarachnoid Hemorrhage: High-volume centers. Neurocrit Care 2011; 15:369–372

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Oliver Freudenreich M.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Freudenreich, O., Henderson, D.C., Sanders, K.M. et al. Training in a Clozapine Clinic for Psychiatry Residents: A Plea and Suggestions for Implementation. Acad Psychiatry 37, 27–30 (2013). https://doi.org/10.1176/appi.ap.11090159

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1176/appi.ap.11090159

Keywords

Navigation