The efficacy of clozapine in patients with treatment refractory schizophrenia was established in the NIMH multi-centre study, published in 1988. 1 Schizophrenia is a potentially very disabling illness with its peak onset in adolescence and early adulthood. It involves positive symptoms, such as hallucinations, delusions and thought insertion and negative symptoms, such as lack of motivation. The cognitive impairments associated with schizophrenia are increasingly recognised as important.
Lack of insight is often a feature and medication non-compliance is common.
Some persons living with chronic refractory schizophrenia may be itinerant, or flee from experiences of persecution, resulting in treatment in multiple services, perhaps in different states. It was the opinion of the Committee that because of the risk of agranulocytosis the College should work with the pharmaceutical company in developing a monitoring system that would optimise its benefits and minimise the risk. The final Protocol for the Clozapine Monitoring System grew out of these discussions and the experience of the company from the United States and the United Kingdom with similar monitoring systems. The risk of agranulocytosis and the nature of schizophrenia pointed to the need for this special monitoring system. Local experience has supported the effectiveness of clozapine 2 and multiple studies point to the cost effectiveness of clozapine.