{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T10:19:13Z","timestamp":1787653153850,"version":"build-2736575974"},"reference-count":33,"publisher":"Royal College of Psychiatrists","issue":"5","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"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=\"S2056472426120791_as1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Clozapine is the most effective treatment for individuals with treatment-resistant schizophrenia, but concerns about adverse effects continue to limit its use. In contrast to haematological monitoring, which is governed by established protocols, there is no standardised framework for detection of clozapine-associated myocarditis. Clozapine-induced myocarditis is rare but potentially fatal and typically occurs within the first 4 weeks of treatment. As early symptoms such as fever and tachycardia overlap with common side-effects of clozapine, diagnosis is often delayed, and clozapine may be unnecessarily discontinued. Evidence suggests that routine monitoring of troponin and C-reactive protein (CRP), alongside assessment of vital signs and electrocardiography (ECG), can support earlier detection and safer treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120791_as2\">\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To evaluate cardiac monitoring practice in patients initiating clozapine treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120791_as3\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>We undertook a retrospective review of all patients registered to start clozapine at Kent and Medway Mental Health National Health Service (NHS) Trust between January 2021 and March 2024. Data were collected on baseline ECG completion, weekly troponin and CRP testing during the first 4 weeks, and documented cardiac symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120791_as4\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 219 patients, 180 had complete data. Baseline ECG was completed in 80% of cases. No routine troponin monitoring was identified, and CRP testing was infrequent. Tachycardia occurred in more than 40% of patients. Fifteen patients were referred to cardiology before initiation, as well as six in the first 4 weeks and five thereafter. Twelve patients (7%) discontinued clozapine early, mainly owing to tachycardia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2056472426120791_as5\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The findings indicate an absence of systematic myocarditis monitoring. Incorporating weekly troponin and CRP testing into existing mandatory blood testing could improve safety, guide appropriate cardiology referrals and reduce unnecessary discontinuation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1192\/bjo.2026.12079","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T09:29:02Z","timestamp":1787650142000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Myocarditis monitoring during clozapine initiation: audit of practice in an NHS trust"],"prefix":"10.1192","volume":"12","author":[{"given":"Madelaine","family":"Bridges","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0381np041","id-type":"ROR","asserted-by":"publisher"}],"name":"Kent and Medway NHS and Social Care Partnership 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London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sukhi S.","family":"Shergill","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry, Psychology & Neuroscience, King\u2019s College London"},{"name":"Kent and Medway Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"170","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"S2056472426120791_ref21","doi-asserted-by":"publisher","DOI":"10.1007\/s40263-016-0311-1"},{"key":"S2056472426120791_ref32","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2023.06.003"},{"key":"S2056472426120791_ref3","doi-asserted-by":"publisher","DOI":"10.1111\/acps.13280"},{"key":"S2056472426120791_ref15","doi-asserted-by":"publisher","DOI":"10.1097\/jcp.0b013e31814e5e68"},{"key":"S2056472426120791_ref5","first-page":"561","article-title":"Incidence and management of clozapine-induced myocarditis in a large tertiary 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international adult guideline for making clozapine titration safer by using six ancestry-based personalized dosing titrations, CRP, and clozapine levels","volume":"55","author":"De 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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":"e216"}}