Clozapine use in patients with severe mental illness was associated with a significantly increased risk of death compared with that for the general population. Causation could not be established. Adverse effects and death are common causes of clozapine discontinuation.

Aims and MethodThe National Institute for Clinical Excellence (NICE) has issued guidance on the use of atypical antipsychotic drugs and recommended that patients be involved in a discussion about the antipsychotic prescribed to them. We undertook a study to evaluate information provision and patient choice subsequent to the publication of this guidance. Patients were recruited from the South London and Maudsley Trust and interviewed. Case notes were examined for documentation of informed discussions.ResultsThirty patients were interviewed, of whom 15 claimed to have received no information. Twenty-seven patients felt that they had had no choice in regard to antipsychotic prescribed. None of the patients had documentation in their notes to suggest that they were involved in informed discussions about the antipsychotic they were prescribed.Clinical ImplicationsPatients were not involved in decisions regarding the antipsychotic medication prescribed. Practice did not follow the NICE guidance.