No specific guidance is given on whether or not patients with pre-existing diabetes require closer monitoring; in these cases clinical judgement is often used. Recent studies have found an association between antipsychotic therapy and pneumonia. The link is better established in elderly patients with a possible dose-dependent IBET762 relationship and increased odds ratio

in those treated with atypical antipsychotics [Trifirò et al. 2010; Knol et al. 2008]. More specifically, in the adult population an association between fatal pneumonia and clozapine therapy is also suggested. In one study, pneumonia Inhibitors,research,lifescience,medical was found to be the primary cause of death in the majority of excess deaths seen in clozapine-treated patients [Taylor et al. 2009b]. The exact pathophysiological association between clozapine Inhibitors,research,lifescience,medical and pneumonia is unclear and it is important to note that this later study found that amongst the excess deaths, not one was found to have agranulocytosis at the time of death. Other possible mechanisms include aspiration pneumonia as a result of sialorrhea Inhibitors,research,lifescience,medical [Hinkes et al. 1996] or oesophageal dysfunction [Maddalena et al. 2004]; however, the exact process remains uncertain. Currently there is no formal guidance on monitoring

or early intervention for this complication in clozapine-treated patients. We present a case of a 43-year-old patient with schizoaffective disorder and pre-existing diabetes, who in the fourth week of clozapine therapy presented in a hyperglycaemic crisis and subsequently developed fatal pneumonia. We later discuss the clinical implications of safely monitoring

these rare but potentially fatal adverse Inhibitors,research,lifescience,medical effects. Case presentation Mr D was a 43-year-old patient of Afro-Caribbean origin, with an established diagnosis of schizoaffective disorder. He first became unwell aged 24 years and experienced numerous episodes of illness characterized by thought disorder, paranoid delusions Inhibitors,research,lifescience,medical and affective symptoms. These episodes were often associated with severe self neglect and aggression and required both voluntary and involuntary admissions to psychiatric wards for management. Despite often successful resolution of his symptoms with psychotropic management, Mr D was difficult to manage in the community because of poor compliance with medication, nonengagement with services and concomitant illicit drug use. In terms of function, he was able to live relatively GBA3 independently early on in his illness, however he required more support over time. His physical health was also of concern; he developed type 2 diabetes mellitus at the age of 41, had hypertension and a degree of chronic obstructive pulmonary disease (COPD), all of which required medical treatment. Contributory factors were morbid obesity, sedentary lifestyle, poor diet and heavy smoking. Approximately 18 months before his death, Mr D was admitted to an acute psychiatric ward as an involuntary patient following a relapse in his mental state.