hardclozapinetreatment-resistant schizophreniaREMSANC monitoringagranulocytosisantipsychotic
A 34-year-old man with schizophrenia has been referred to a community mental health center for treatment-resistant symptoms. He has documented adequate trials of risperidone, olanzapine, and aripiprazole over the past four years, each at therapeutic doses for at least eight weeks, with persistent auditory hallucinations and disorganized thinking despite adherence confirmed by long-acting injectable formulations. His baseline absolute neutrophil count (ANC) is 2,800 cells/microL, fasting glucose is 95 mg/dL, and BMI is 27. He has no history of seizure disorder, cardiomyopathy, or prior clozapine exposure. The PMHNP is developing a plan for clozapine initiation. Which of the following best represents the appropriate treatment planning approach?