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1 results

  • The assertive approach to clozapine: nasogastric administration

  • Alex Till, James Selwood, Edward Silva
  • Journal:
    BJPsych Bulletin / Volume 43 / Issue 1 / February 2019
    Published online by Cambridge University Press:
    18 September 2018, pp. 21-26
    Print publication:
    February 2019
    • Article
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      • Open access
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  • Aims and method

    An ‘assertive approach’ to clozapine, where nasogastric administration is approved, is assessed through a case-load analysis to provide the first systematic description of its use and outcomes worldwide.

    Results

    Five of the most extremely ill patients with treatment-resistant schizophrenia were established and/or maintained on clozapine, resulting in improvements to their mental state; incidents were reduced, segregation was terminated and progression to less restrictive environments was achieved.

    Clinical implications

    Despite being underutilised and rarely enforced, in extreme circumstances, an assertive approach to clozapine can be justified. Nasogastric clozapine can be safely delivered and the approach itself, rather than actual nasogastric administration, may be enough to help establish and maintain patients with treatment-resistant schizophrenia on the most effective treatment.

    Declaration of interest

    E.S. has received speaker fees from Jansen Pharmaceuticals and Novartis.