Table 1 A mental health service user dies of a cardiac arrest

A mental health service user died from a cardiac arrest whilst being treated as an inpatient after being admitted to an acute mental health ward. Patient B had been prescribed a new generation anti-psychotic drug used in the treatment of schizophrenia (clozapine). Review of patient B’s notes over a 4-year time frame identified several recorded entries where she had raised concerns about the cardiac side effects of clozapine. She had been experiencing heart palpitations and was diagnosed with tachycardia following referral for cardiac review.

During this 4-year time frame, patient B was living independently in the community, supported by her family, a community mental health team and GP. She made repeated requests for her medication to be changed to the GP and community mental health team. Her concerns were not acted on even though the National Institute for Health and Care Excellence (NICE) guidelines on the prevention and management of schizophrenia emphasise that the choice of anti-psychotic medication should take the patient’s views into account:

The United Kingdom NICE Guideline CG 178, Psychosis and Schizophrenia in Adults: prevention and Management states: ‘The choice of antipsychotic medication should be made by the service user and healthcare professional together, taking into account the views of the carer if the service user agrees. Provide information and discuss the likely benefits and possible side effects of each drug, including:

 • metabolic (including weight gain and diabetes)

 • extrapyramidal (including akathisia, dyskinesia and dystonia)

 • cardiovascular (including prolonging the QT interval)

 • hormonal (including increasing plasma prolactin)

 • other (including unpleasant subjective experiences).’

Because of the physical symptoms she was experiencing, patient B repeatedly stopped taking clozapine. The healthcare professionals involved in her care focused on persuading patient B she should keep taking clozapine. There is no evidence anyone considered ‘Patient B is experiencing physical side effects from taking clozapine. The heart palpitations she is experiencing are causing considerable anxiety. She is at high risk of medication non-compliance.’ She eventually died of a cardiac arrest while in hospital for her mental health problems.