title: Optimizing clozapine through clinical decision making.
abstract: OBJECTIVE
  Recognizing and incorporating the patient's own perspective into treatment recommendations are essential to optimizing clozapine use. The study describes how the patient's perspective influences clinicians' decision strategies and affects their clozapine recommendations.
  
  
  METHODS
  Psychiatric trainees examined six case vignettes of varying complexity that included clinical and patient perspective information. They made treatment recommendations guided by a well-known switching guideline and rated the factors that influenced their recommendations.
  
  
  RESULTS
  The decision to follow the guideline's switch recommendation was influenced principally by the importance of the patient's positive symptom profile. The decision to recommend clozapine in lieu of another treatment was influenced principally by the importance of patient's perspective and patient-specific clinical information. These factors had a significant combined influence on the clozapine recommendation rate: When clinical factors were moderately important, the rate was 8%. When clinical factors were extremely important, the rate was 22% when the patient's perspective was moderately important, but 80% when the patient's perspective was very or extremely important.
  
  
  CONCLUSIONS
  A clozapine optimization strategy requires skill in advanced decision making, and specifically in prioritizing the patient's perspective without diminishing the importance of clinical information. This skill can be developed through practice-based learning.
authors.affiliation: VA Connecticut Healthcare System, Clinical Epidemiology Research Center, West Haven, CT 06516, USA. paul.falzer@yale.edu
authors.forename: P R
authors.initials: PR
authors.lastname: Falzer
authors.forename: D M
authors.initials: DM
authors.lastname: Garman
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003024:Clozapine / Q000008:administration & dosage / Q000627:therapeutic use*; D003657:Decision Making; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D011570:Psychiatry / Q000193:education; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D003024:Clozapine