{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T15:48:42Z","timestamp":1792684122761,"version":"4.5.0"},"reference-count":94,"publisher":"Royal College of Psychiatrists","issue":"3","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"unspecified","delay-in-days":10,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["BJPsych open"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec id=\"S2056472426110242_as1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Clozapine is the gold-standard treatment for treatment-resistant schizophrenia but carries serious cardiac risks, including sudden cardiac death (SCD). Specific risk factors for SCD in clozapine-treated patients remain poorly defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426110242_as2\">\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To systematically identify and synthesise evidence on risk factors for SCD and sudden unexplained death (SUD) in clozapine-treated patients, to guide clinical monitoring.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426110242_as3\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>We conducted a systematic review following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines (PROSPERO, no. CRD420250646384). Five databases were searched from inception to 13 October 2025. Studies reporting SCD or SUD in clozapine-treated patients were included without restrictions on study design, demographics or diagnosis. Two reviewers independently screened studies and extracted data. Quality was assessed using Joanna Briggs Institute checklists and Risk Of Bias In Non-randomised Studies of Exposures tools. Given study heterogeneity, we performed structured narrative synthesis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426110242_as4\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-one studies (1989\u20132023) were included, comprising 498 cases of SCD\/SUD in clozapine-treated patients. Risk factors were grouped into four categories: treatment intensity (high doses (\u2265525 mg\/day), rapid titration), drug interactions (valproate, benzodiazepines, polypharmacy), lifestyle factors (smoking, obesity, diabetes, substance use) and monitoring. Two patterns emerged: early inflammatory myocarditis (weeks 2\u20136) and late-onset cardiomyopathy (months\u2013years).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426110242_as5\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Clozapine-associated SCD appears multifactorial. These findings suggest a role for gradual titration, avoidance of high-risk co-medications, baseline biomarker monitoring and ongoing management of metabolic and cardiovascular risk factors. Increased multidisciplinary surveillance may help identify patients at higher risk and inform clinical decision-making in clozapine-treated patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1192\/bjo.2026.11024","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T04:03:41Z","timestamp":1778472221000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":2,"title":["Risk factors for sudden cardiac death or sudden unexplained death in patients treated with clozapine: systematic review"],"prefix":"10.1192","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-5363-0367","authenticated-orcid":false,"given":"Tejas","family":"Easwar","sequence":"first","affiliation":[{"name":"University of Cambridge"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damodar","family":"Chari","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/045wcpc71","id-type":"ROR","asserted-by":"publisher"}],"name":"Leicestershire Partnership NHS Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahbaz","family":"Abdullah","sequence":"additional","affiliation":[{"name":"Leicestershire Partnership NHS Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugh","family":"Tollinton","sequence":"additional","affiliation":[{"name":"Leicestershire Partnership NHS Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeta B. 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