{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T05:30:46Z","timestamp":1786339846708,"version":"build-2736575974"},"reference-count":37,"publisher":"Royal College of Psychiatrists","issue":"5","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"unspecified","delay-in-days":0,"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":[[2026,9]]},"abstract":"<jats:sec id=\"S2056472426120699_as1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Clozapine reduces overall mortality and suicide risk in schizophrenia, but the specific causes and clinical contexts of death among clozapine-treated patients remain less well characterised.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120699_as2\">\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>We aimed to characterise causes of death in clozapine-treated patients within a defined UK catchment area over 17 years (2009\u20132025); compare features across predefined mortality clusters (suicide, expected, unexpected); compare unexpected death cases with a clozapine-treated comparison cohort alive in 2019 and examine temporal mortality patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120699_as3\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>We conducted a retrospective, descriptive cohort study of all deaths among clozapine-treated patients within a UK mental health National Health Service Trust between 1 January 2009 and 31 December 2025. Deaths were classified into suicide, expected and non-intentional unexpected, using a previously established framework. Variables were compared across clusters and between unexpected death cases and a clozapine-treated comparison cohort alive in 2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120699_as4\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 87 deaths, 11 (12.6%) were suicides, 29 (33.3%) were expected and 47 (54.0%) were non-intentional unexpected. Malignancy was the most common cause (21\/87, 24.1%), followed by cardiovascular (13\/87, 14.9%) and respiratory or infective causes (9\/87, 10.3%). Age differed across clusters (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.005), with suicides at younger ages. Compared with the 2019 cohort, patients who died unexpectedly were older (55.0\n                      <jats:italic>v<\/jats:italic>\n                      . 48.6 years,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.006) and more likely to smoke (75.0\n                      <jats:italic>v<\/jats:italic>\n                      . 34.6%,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001). Annual mortality peaked in 2021 and was not fully explained by direct COVID-19 deaths.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120699_as5\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Mortality in clozapine-treated patients arises across diverse clinical contexts, with more than half classified as non-intentional unexpected. Findings support sustained physical health monitoring, closer attention to smoking and other modifiable risks, and continuity of care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1192\/bjo.2026.12069","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T05:27:29Z","timestamp":1786339649000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Causes of death and mortality patterns in clozapine-treated patients: 17-year retrospective cohort study"],"prefix":"10.1192","volume":"12","author":[{"given":"Mar","family":"Alonso-Garcia","sequence":"first","affiliation":[{"name":"Gregorio Mara\u00f1\u00f3n General University Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Seabright","sequence":"additional","affiliation":[{"name":"Cambridgeshire and Peterborough NHS Foundation 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ONS, 2024 (https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/birthsdeathsandmarriages\/lifeexpectancies\/bulletins\/nationallifetablesunitedkingdom\/2022to2024 [cited 1 May 2026])."},{"key":"S2056472426120699_ref26","doi-asserted-by":"publisher","DOI":"10.1192\/bjo.2021.45"},{"key":"S2056472426120699_ref34","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(25)00098-7"},{"key":"S2056472426120699_ref11","doi-asserted-by":"publisher","DOI":"10.1016\/j.euroneuro.2020.05.011"},{"key":"S2056472426120699_ref33","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2015.07.052"},{"key":"S2056472426120699_ref18","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-020-04215-y"},{"key":"S2056472426120699_ref2","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20699"},{"key":"S2056472426120699_ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2023.07.014"},{"key":"S2056472426120699_ref16","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0287122"},{"key":"S2056472426120699_ref31","doi-asserted-by":"publisher","DOI":"10.1016\/j.rpsm.2023.04.002"},{"key":"S2056472426120699_ref32","doi-asserted-by":"publisher","DOI":"10.1192\/bjo.2021.1046"},{"key":"S2056472426120699_ref8","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60742-X"},{"key":"S2056472426120699_ref17","doi-asserted-by":"publisher","DOI":"10.1007\/s40263-017-0448-6"},{"key":"S2056472426120699_ref6","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2024.88"},{"key":"S2056472426120699_ref24","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1004457"},{"key":"S2056472426120699_ref15","doi-asserted-by":"publisher","DOI":"10.1016\/j.euroneuro.2025.112747"},{"key":"S2056472426120699_ref30","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(20)30307-2"}],"container-title":["BJPsych Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S2056472426120699","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T05:27:30Z","timestamp":1786339650000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S2056472426120699\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,10]]},"references-count":37,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["S2056472426120699"],"URL":"https:\/\/doi.org\/10.1192\/bjo.2026.12069","relation":{},"ISSN":["2056-4724"],"issn-type":[{"value":"2056-4724","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,10]]},"assertion":[{"value":"\u00a9 The Author(s), 2026. Published by Cambridge University Press on behalf of Royal College of Psychiatrists","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e213"}}