Following a meeting between XXXXX ZXXXX, principal pharmacist, and Dr HHHHHH, it was agreed that:

1. All patients started on clozapine treatment from march 1998 would be included in the audit

2. Using an annotated assessment form provided by Novartis, the patient's mental state and social functioning would be assessed

a) prior to commencement of clozapine treatment

b) at 3 monthly intervals until 1 year has elapsed since starting treatment

3. Assessments to be carried out by Dr VVVVVVV and a successive doctor

The following scoring codes to be used:

Initial assessment:

Subsequent assessments:

0 = absent; 2.= present

0 = absent; 1 = improved significantly; 2 =no change

A record will be made by the pharmacist responsible for that ward/area of all psychotropic medicine received by the patient:

a) for 6 months prior to treatment (if known)

b) at 3 month and subsequent assessments

c) at final assessment

Standard: All patients started on clozapine should be regularly monitored and improvement demonstrated to justify continuation of treatment

Clinical Evaluation

A. Positive Symptoms

1. Auditory/visual hallucinations

2. Unusual thought content

B. Negative Symptoms

3 Emotional withdrawal

4. Lack of spontaneity

5. Blunted affect

C. Cognitive Deficits

6. Attention difficulties

7. Memory/recall difficulties

D. Behavioural Disturbance

8. Bizarre appearance

9. Aggressive behaviour towards others

10. Hostility/aggression

E. Social Functioning

11. Inability to develop/maintain personal relationships

12. Moderate/severe conflicts with caregivers

13. Moderate/severe conflicts with family

14. Inability to tolerate or be accepted by housing facility

F. Work/school functioning

15. Employment-related failures related to mental illness

16. Inability to complete appropriate education or vocational training

G. Depression/suicide risks

17. Persistent depression or hopelessness

18. Suicidal thoughts/plans/threats

19. Suicide attempts

H. Rehospitalisation/chronic hospitalisation/persistent partial hospitalisation

20. Episode(s) or hospitalisation

I. Extrapyramidal side effects; movement disorder

21. Akathisia

22. Tremor

23. Muscular stiffness/rigidity

J. Substance Abuse

24. Excessive use of alcohol or other drugs of abuse as self-medication