Background
The symptoms presented by the patient suggest that the diagnosis is schizophrenia. Clozapine is a drug commonly prescribed to manage the aforementioned condition due to its antipsychotic properties. As the individual is experiencing auditory hallucinations and delusions, Clozapine can alleviate both the positive and negative effects of schizophrenia that affect the subject’s life and well-being. Class-wise, the medication is categorized as an atypical antipsychotic (Haidary & Padhy, 2021).
Regarding its mechanism of action, the drug blocks the activity of dopamine and serotonin receptors. Namely, it is a D2 antagonist, implying that it prevents dopamine from binding to D2 receptors while binding to D4 receptors. The efficacy of the drug generates positive results for individuals with schizophrenia, even in cases in which the condition has been proven to be resistant to other treatments.
Evidence
Clozapine is a relatively old medication that has been on the market for multiple decades. Much research has been conducted to ensure the drug’s efficacy. Researchers have highlighted that people taking it long-term are more likely to describe themselves as positively functioning (more than 70%) compared to 0% at baseline (Lee et al., 2023). Additionally, the same study found beneficial changes regarding reductions in suicidal thoughts. The results can be attributed to the current patient, as the report illustrates a lack of social and professional life and interests.
Additionally, research suggests individuals on the antipsychotic in question are more likely to be employed (Matsuzaki et al., 2023). This is another piece of evidence correlating with increased functioning and well-being. The medication has been effective in alleviating the main symptom reported by the patient, namely auditory hallucinations, in 75% of cases (Chung et al., 2021). It can be concluded that the approach is indeed evidence-based and supported by relevant literature on psychopharmacology.
Side Effects
It is important to consider the common side effects associated with Clozapine use. Agranulocytosis is a condition that occurs in 1% of individuals prescribed the medication and is characterized by a decrease in white blood cell (WBC) counts (Haidary & Padhy, 2021). Myocarditis, metabolic changes, seizures, and constipation have also been found to be potentially linked to individuals who take Clozapine in rare cases.
Other possible adverse effects include excessive salivation and an increased risk of developing pulmonary embolisms (Haidary & Padhy, 2021). Despite the adverse effects that can affect a person’s well-being, it is vital to note that they occur in a small percentage of the population. Simultaneously, it is critical to remain in contact with the subject and monitor changes to mitigate risks and adjust the treatment.
Testing
Due to the patient’s existing adverse effects, monitoring through testing can help minimize these barriers. As previously highlighted, the WBC count can decrease, which is why it is critical to test it before treatment (Haidary & Padhy, 2021). The test is also to be administered weekly for the first half-year after the medication is prescribed, and the results are to fall within the range of 4,500 to 11,000 WBCs per microliter (WBC count, 2023). The measure is a preventive measure to avoid health risks.
Teaching Points
Three teaching points to be discussed with the patient and family members include monitoring blood, reporting potential infections, and adhering to the prescribed treatment. Blood monitoring is a weekly procedure that can be inconvenient yet essential for avoiding the adverse effects associated with the medication (Haidary & Padhy, 2021). Additionally, due to existing threats, the individual is to be informed to contact medical providers in case of infections, as a low WBC count can facilitate them. Last but not least, it is vital to be consistent when it comes to taking Clozapine to ensure its efficacy in addressing schizophrenia symptoms.
References
Chung, I. W., Kim, H. S., Kim, J. H., Jang, J. H., & Kim, Y. S. (2021). Resolution of persistent auditory verbal hallucinations after long-term electroconvulsive therapy maintenance: A case report of a patient with clozapine-resistant schizophrenia. Clinical Psychopharmacology and Neuroscience, 19(1), 170–173.
Haidary, H. A., & Padhy, R. K. (2021). Clozapine. StatPearls.
Lee, M. A., Cola, P., Jayathilake, K., & Meltzer, H. Y. (2023). Long-term outcome of Clozapine in treatment-resistant schizophrenia. Journal of Clinical Psychopharmacology, 43(3), 211–219.
Matsuzaki, H., Hatano, M., Iwata, M., Saito, T., & Yamada, S. (2023). Effectiveness of Clozapine on employment outcomes in treatment-resistant schizophrenia: A retrospective bidirectional mirror-image study. Neuropsychiatric Disease and Treatment, Volume 19, 615–622.
WBC count. Mount Sinai Health System. (2023).