Clozapine and the treatment of schizophrenia.

Clozapine, an atypical antipsychotic medication, is the most significant pharmacological advancement in the treatment of chronic schizophrenia in years. Effective in treating the nearly 30 percent of people with schizophrenia who do not respond to conventional pharmacological and psychosocial therapies, clozapine offers new hope to many. However, high cost, a potentially lethal side effect, and a weekly mandatory monitoring system have hampered access to clozapine treatment. This article reviews a brief history of clozapine use in the United States and also the unique features of the medication. Economic, ethical, and personnel resource issues of clozapine use are summarized. The author describes her clinical experiences with the psychosocial issues faced by those who respond to clozapine treatment, case highlights, and social work interventions. Social work advocacy for increased access to clozapine, the potential contributions of social workers in the selection of patients for treatment, and the logistical management issues confronting social workers in inpatient and outpatient mental health settings are addressed.