Using clozapine in clinical practice

MCQs 3 For persistent positive symptoms, the 5 You wish to rechallenge a patient who Select the single best option for each question stem following are of no merit: developed neutropenia on clozapine after a a trial of anticonvulsant medication 5 years. It is always essential to involve 1 Clozapine is not associated with: b a trial of depot medication the following people except: a eosinophilia c a trial of two antipsychotic drugs with differing a hospital pharmacy staff b hypothyroidism mechanisms of action b the care coordinator c myocarditis d low-dose amisulpride monotherapy c the clozapine monitoring agency d tachycardia e urinary screens for illicit drugs. d the independent mental health capacity e type II diabetes. advocate 4 Patients on clozapine treatment e the patient. 2 Clozapine should not be given if the experience the following: patient: a benefit from ‘awakenings’ experiences a develops tachycardia, dyspnoea and chest pain b direct benefit on primary negative symptoms b has a BMI of 35 kg/m3 c gradual global functional improvement over a c has an eosinophil count of 2.9 x 109/l number of years d has benign fluctuating neutropenia d reduced risk of major depressive episode e lacks parenting capacity. e remediation of premorbid cognitive impairment.

‘Why I wrote The Yellow Wallpaper? ’, IN other words by Charlotte Perkins Gilman Selected by Femi Oyebode

Many and many a reader has asked that. When the Then, using the remnants of intelligence that Charlotte Perkins Gilman (1860– story first came out, in the New England Magazine remained, and helped by a wise friend, I cast the 1935) first suffered depression in 1882. After giving birth to a about 1891, a Boston physician made protest noted specialist’s advice to the winds and went daughter in 1885 her depression in The Transcript. Such a story ought not to be to work again — work, the normal life of every worsened. She entered a sanatorium written, he said; it was enough to drive anyone human being; work, in which is joy and growth in 1887, under the care of Dr mad to read it. and service, without which one is a pauper and a Silas Weir Mitchell, the American physician, psychiatrist and writer. Another physician, in Kansas I think, wrote parasite; ultimately recovering some measure of Gilman recovered but experienced to say that it was the best description of incipient power. another depressive episode in 1889. insanity he had ever seen, and — begging my Being naturally moved to rejoicing by this She took her own life by chloroform pardon — had I been there? narrow escape, I wrote The Yellow Wallpaper , poisoning in 1935, while suffering the final stages of breast cancer. Now the story of the story is this: with its embellishments and additions to carry out The Yellow Wallpaper was first For many years, I suffered from a severe and the ideal (I never had hallucinations or objections published in 1892, in The New continuous nervous breakdown tending to to my mural decorations) and sent a copy to the England Magazine. This excerpt, originally from Gilman’s own melancholia — and beyond. During about the physician who so nearly drove me mad. He never magazine The Forerunner (October third year of this trouble I went, in devout faith acknowledged it. 1913) is reprinted in The Yellow and some faint stir of hope, to a noted specialist in The little book is valued by alienists and as a Wallpaper (edited by Dale M. nervous diseases, the best known in the country. good specimen of one kind of literature. It has to Bauer), Bedford Books, 1998, pages 348–349. This wise man put me to bed and applied the rest my knowledge saved one woman from a similar cure, to which a still good physique responded fate — so terrifying her family that they let her out doi: 10.1192/apt.17.4.265 so promptly that he concluded there was nothing into normal activity and she recovered. much the matter with me, and sent me home with But the best result is this. Many years later I solemn advice to “live as domestic a life as far as was told that the great specialist had admitted possible,” to “have but two hours’ intellectual life to friends of his that he had altered his treat­ a day,” and “never to touch pen, brush or pencil ment of neurasthenia since reading The Yellow again as long as I lived.” This was in 1887. Wallpaper . I went home and obeyed those directions for It was not intended to drive people crazy, but some three months, and came so near to the border to save people from being driven crazy, and it line of utter mental ruin that I could see over. worked.

Advances in psychiatric treatment (2011), vol. 17, 256–265 doi: 10.1192/apt.bp.110.008136 265