Symptom Monitoring

Develop a good working alliance with the patient. When a solid therapeutic foundation is not formed, patients are frequently reluctant to share their psychotic experiences. Once a solid working relationship and some knowledge of the patient's psychotic experiences exist, perform a more structured interview. Many assessments are available to more objectively rate positive and negative symptoms, level of function, and life satisfaction. The most commonly used scales include:

Table 37-10 Monitoring Protocol for Patients on SGAs

B aiihnt

4 Weeks

B Wtrki

12 Weeks



Every 5 Yean

Perional/famijy history0








'r'l'jM'nl HjiNAirnlii;,NlLiVi:;L



Elood pmsuiii




Fasting plasma glucose




Fating (ilium lipids




"Of obesity dlrttwiPSi dyslipideima, frypei tension, or cardiouasculai disea*?. Hionn fief 5?.

Table 37-11 Monitoring of WBC and Absolute Neutrophil Count During Clozapine Treatment

Hem-oTologic Val uci

Frequent? ol WBC and ANC


Pi 101 to cknaiilne Initiation

Initialen to 6 months 6-12 months

After I? months of thejapy

Whenever cloiapii*.' is d-iccnlinuod

M'ct leukopenia or granulocytopenia

Müdwatt k.ijlijDpL'fiLj or QiinukKylOiJinia

SrviTF iMhcpcnijl nr tirjnukiryltJrx'ni.i. of agranulocytosis

Recommended levefe "iVBC (j-eawr than or equal m ii x lOVhm1 and ANC giojtcf Hun 01 «jual lo 2 X W/ntfn' ho hlstoiy of a myeloproliferative disorder or ckMiifiii*" indutsd jqijnul« ylcw WBC greater than dt equal to A5 x lD'-mim'and ANC

greater than nr equal to IX lOVmm1 W8C greater than or equal to ii x lDVmm1 aiid ANC

QiMier (hjiioi KquSlW I v lCWrvn' WBC greater than or equal to A5 x lOVmm' and ANC Qi^ier (hiii or L^HJil tt> ?K tCH/irmn1

VtoC value lies between 3 x M'/mm and 35* If/mm' .ytifoi AM, h-ibtflwfiH 1 ^ V Kr/rrn I n ici .-1 X Ki/i-Vn'

WBC viluL' Ik*. bMwecfi 2 k lOVnini' and 3 x 107mm' and** AWT. value Ii« tKiyieen I x ltf/mm and 15 * lOVrnm1

Witt Iit, 10 Arm1 aixitir AMC i^ltvin

Weekly for 6 months Every 2 weeVs for & nwvlhs Every 4 weei<s

Wtwkl/ (or afl least ^ weits from day of disconrinuaiioii Twice weetly urrtil returned ft?

M^UIlTir^TMliTl hvrls

HWfnjpl Ihuapy: monitoi s.lj-.'vy until WSf i>ei(efThsn 3 x Kf/rtim an<f

AMC gieater than l.S x lOVtnm1, then iwke weeftly Jjjc* b recomrmended levels pivignflini.H'-iiH^tnwnl <iiyt ^ty n;il iectulk.YK)e. rinonnof daily utkiI WBC grealer Ihsn 3 x Bytnmfand AHL (jk'JItl tan lj K tOVnuii'. then twice weekly uniil back to IVCOriYtMdsd Icvi.^

AitCihsoiuSi rievi ■■ ii iii ^o^nt. WPC ^Wnt Mood Wll WUfH

IQ'/irmV 3,5 * toVL 3 x HWmm1 3 x tQyl,-2 X Kjymiin1 2v 10/L 1,5 * HftttWi 1 5-ii 10VL1 x ltf/Hmf 1 x l-P'/L-Qi x O.ix IFA.

• Positive and Negative Symptom Scale (PANSS)

• Brief Psychiatric Rating Scale (BPRS)

• Clinical Global Impression (CGI) Scale

Using these scales on a regular basis, particularly when switching medications or changing doses, is a more reliable means of monitoring for improvement. Certainly symptom assessments cannot capture the full range of possible improvements a patient may experience, but they can be useful in deciding whether a medication is having substantial benefit.

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