There are a lot of broad issues here where a doc has to know the specifics. If a patient has treatment resistant psychosis where nothing else worked except Clozapine, of course they have to be on it unless that person's psychosis is not that bad (unlikely), or they are not healthy enough to take it.
The standard on paper is two antipsychotics needed to be tried and failed. I think that standard should be changed given how many newer antipsychotics we now have.
Another view is several patients on Clozaril do better on it (as measured in CATIE) vs other atypicals to the degree where some notables in psychiatry have argued that perhaps we should be considering it earlier. While that is not my own view, I see where they're coming from, and fully acknowledge I might be wrong about this.
I have treated dozens of patients on Clozaril. Unless you've done long-term or forensic psychiatric units, your'e likely not in a position where you've seen several patients who need it. Most doctors I've seen in settings other than long-term or forensic only see Clozapine patients rarely and get scared when dealing with them. Further, IMHO, the data regarding it is rather user unfriendly, having to read several documents then piece together what to do.
A colleague of mine made a very cohesive, easy to understand, and user-friendly state manual for the use of Clozapine within a treatment setting for the Ohio Dept. of Mental Health that incorporates very useful data often not found in textbooks. If you give me your e mail, and I got the time, I could scan it and email it to you. Please be aware that I'm up to my eyeballs in work, having worked 7 days a week for the past few weeks because I'm working on a private forensic case on top of my usual job and I got to fish for this manual that may be difficult for me to find.
