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ForwardMGB AMC Morbidity & Mortality Series: December 9, 2025 - Clozapine
Clinical practices in health care systems must have review processes and procedures in place to limit adverse outcomes with identifying practices gaps and improving existing knowledge of physicians. One such process is the morbidity and mortality conference which aims to focus on review of adverse outcomes to identify system or practice errors and improve patient safety. This is achieved through structured case-based discussion of specific patients, root-cause analysis, and collaborative discussion among physicians. Through presentation and discussion of a case example and literature review, participants in the conference will enhance their understanding and knowledge of pharmacokinetics of clozapine and medical complications associated with catatonia.
Clozapine is indicated as a therapeutic option for treatment-resistant schizophrenia; however, its use is limited due to potential for serious adverse effects including granulocytopenia, myocarditis, and constipation. The pharmacokinetics of clozapine are affected by numerous parameters and can present with inter- and intra-individual variability with factors such as age, sex, genetics, dietary, drug interactions, and acute medical illness contributing to variability. Monitoring for side effects incorporates attaining clozapine plasma levels. A recent systematic review outlined that certain side effects appeared to be demonstrate a positive correlation with plasma clozapine levels such as obsessive-compulsive symptoms, heart rate variability, hyperlipidemia, paralytic ileus, colonic hypomotility, etc. while others did not present with a significant correlation with plasma levels such as extrapyramidal symptoms, QTc prolongation, tachycardia, sialorrhea, etc. (Skokou et al, 2022) Additionally, it has been noted that acute medical illness causing systemic inflammation can increase clozapine levels and potentially lead to more adverse outcomes. (de Leon et al, 2020) Therapeutic drug monitoring, appropriate interpretation of levels, and improved awareness of pharmacokinetics and potential side effects is crucial in clinical practice for patients on clozapine to identify side effects early and provide treatment options.
An accompanying consideration for clinicians is the presence of co-morbid psychiatric illnesses which may increase the risk of medical complications in these patients. Of particular interest in the case example provided will be complications associated with catatonia such as pneumonia, urinary tract infection, sepsis, deep venous thrombosis, pulmonary embolism, acute kidney injury and cardiac arrhythmia. (Hirjak et al, 2024) Prompt recognition, management of catatonia, and close monitoring are essential to prevent serious complications. Assessments of symptoms suggestive of potential medical illness can be difficult to assess in a patient experiencing catatonia as they may have limited ability to communicate somatic complaints. Along with timely treatment, consideration of potential medical illness and complications should be incorporated into evaluation for patients suffering from catatonia.
Target Audience
This program is intended primarily for Psychiatrists; other allied staff, such as Psychologists, Physicians from other specialties, Nurses, Physician Assistants, Nurse Practitioners, and Social Workers, are welcome to attend.
Learning Objectives
Upon completion of the activity, participants will be able to:
- Identify side effects for clozapine.
- Analyze risk for development of medical complications associated with catatonia.
- Assess and incorporate probabilities for development of medical illness into plan of care for patients with catatonia
Presenters:
Ashika Bains, MD; Alexandra Clay, MD; Alexandra Palmer, MD
Presenters:
Ashika Bains, MD; Alexandra Clay, MD; Alexandra Palmer, MD
The presenters have no financial disclosures to report.
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Target Audience
This program is intended for: Psychiatrists, Physicians
This program is intended primarily for Psychiatrists, other allied staff such as Psychologists, Physicians from other specialties, Nurses, Physician Assistants, Nurse Practitioners, and Social Workers, are welcome to attend. Participants can receive up to 1.0 CE.
Accreditation
In support of improving patient care, MGH Institute of Health Professions is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.
1.0 Physicians
MGH Institute of Health Professions designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits ™. Physicians should claim only credit commensurate with the extent of their participation in this activity.
1.0 Nursing
MGH Institute of Health Professions designates this activity for 1.0 contact hours for nurses. The American Academy of Nurse Practitioners Certification Board (AANPCB) accepts credit from organizations accredited by the ACCME and ANCC.
1.0 Psychologists
Continuing Education (CE) credits for psychologists are provided through the co-sponsorship of the American Psychological Association (APA) Office of Continuing Education in Psychology (CEP). The APA CEP Office maintains responsibility for the content of the programs. MGH Institute of Health Professions designates this activity for 1.0 CE credit.
1.0 Social Workers
As a Jointly Accredited Organization, MGH Institute of Health Professions is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. MGH Institute of Health Professions maintains responsibility for this course. Social workers completing this course receive 1.0 clock hours for continuing education credits.
1.0 IPCE Credit
This activity was planned by and for the healthcare team, and learners will receive 1.0 Interprofessional Continuing Education (IPCE) credits for learning and change.
* This activity designed to meet the criteria for risk management study in Massachusetts.
Available Credit
- 1.00 AMA PRA Category 1 Credit™
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of IHP and Massachusetts General Hospital. IHP is accredited by the ACCME to provide continuing medical education for physicians.
IHP designates this Enduring activity for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
- 1.00 Nursing Contact Hours
Massachusetts General Laws, Chapter 13, sections 13, 14, 14A, 15 and 15D and Chapter 112, sections 74 through 81C authorize the Board of Registration in Nursing to regulate nursing practice and education.
This program meets the requirements of the Massachusetts Board of Registration in Nursing (244 CMR 5.00) for 1.00 contact hours of nursing continuing education credit. Advance practice nurses, please note: Educational activities which meet the requirements of the ACCME (such as this activity) count towards 50% of the nursing requirement for ANCC accreditation.
- 1.00 Social Workers
As a Jointly Accredited Organization, the MGH Institute of Health Professions is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. MGH Institute of Health Professions maintains responsibility for this course. Social workers completing this course receive 1.00 clock hours for continuing education credits.
- 1.00 Participation
This course allows other providers to claim a Participation Certificate upon successful completion of this course.
Participation Certificates will specify the title, location, type of activity, date of activity, and number of AMA PRA Category 1 Credit™ associated with the activity. Providers should check with their regulatory agencies to determine ways in which AMA PRA Category 1 Credit™ may or may not fulfill continuing education requirements. Providers should also consider saving copies of brochures, agenda, and other supporting documents.
- 1.00 Psychologists CE Credit
Continuing Education (CE) credits for psychologists are provided through the co-sponsorship of the American Psychological Association (APA) Office of Continuing Education in Psychology (CEP). The APA CEP Office maintains responsibility for the content of the programs. MGH Institute of Health Professions designates this activity for 1.00 CE credit.
Accreditation
In support of improving patient care, MGH Institute of Health Professions is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.
1.0 Physicians
MGH Institute of Health Professions designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits ™. Physicians should claim only credit commensurate with the extent of their participation in this activity.
1.0 Physician Associates/Assistants
AAPA Credit Designation Statement – Live
MGH Institute of Health Professions has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1.0 AAPA Category 1 CME credits. PAs should only claim credit commensurate with the extent of their participation.
AAPA Credit Designation Statement – Enduring Materials
MGH Institute of Health Professions has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1.0 AAPA Category 1 CME credits. Approval is valid until {Expiration Date). PAs should only claim credit commensurate with the extent of their participation.
1.0 Nursing
MGH Institute of Health Professions designates this activity for 1.0 contact hours for nurses. The American Academy of Nurse Practitioners Certification Board (AANPCB) accepts credit from organizations accredited by the ACCME and ANCC.
1.0 Pharmacists
This activity provides 1.0 contact hours of continuing education credit.
NOTE FOR PHARMACISTS: Upon closing of the electronic evaluation, IHP will upload the pharmacy-related continuing education information to the CPE Monitor within 60 days. Per ACPE rules, IHP does not have access nor the ability to upload credits requested after the evaluation closes. It is the responsibility of the pharmacist or pharmacy technician to provide the correct information [NABP ePID and DOB (in MMDD format)] in order to receive credit for participating in a CE activity.
1.0 Psychologists:
Continuing Education (CE) credits for psychologists are provided through the co-sponsorship of the American Psychological Association (APA) Office of Continuing Education in Psychology (CEP). The APA CEP Office maintains responsibility for the content of the programs. MGH Institute of Health Professions designates this activity for 1.0 CE credit.
1.0 Social Workers
As a Jointly Accredited Organization, MGH Institute of Health Professions is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. MGH Institute of Health Professions maintains responsibility for this course. Social workers completing this course receive 1.0 clock hours for continuing education credits.
1.0 IPCE Credit
This activity was planned by and for the healthcare team, and learners will receive 1.0 Interprofessional Continuing Education (IPCE) credit for learning and change.