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Background: Clozapine has well-documented inter-ethnic variations in pharmacokinetics. There is a paucity of data about clozapine use and associated adverse events such as seizures, obsessive compulsive symptoms, neutropenia, and agranulocytosis, from India. Methods: This retrospective cohort study followed up 228 patients initiated on clozapine in a tertiary care referral center in India for an average of 10 years. We calculated incidence rates of new-onset seizures, new-onset obsessive compulsive symptoms, agranulocytosis, and neutropenia. We collected data on doses of clozapine used and serum assays and calculated concentration-to-dose (C/D) ratios. We also collected relevant clinical details about clozapine-induced seizures. Results: In the sample, 16.8% had new-onset seizures, 12.3% had new-onset OC symptoms, 2.7% had neutropenia, and 0.9% had agranulocytosis. The mean C/D ratio was 2.09 (SD = 1.8). Almost half (46.3%) of available serum assays were in the supra-therapeutic range. Seizures were associated with a higher clozapine dose at one year (OR = 1.003; 95%CI = 1.000–1.006; P value = 0.045) and the presence of positive psychotic symptoms at one year (OR = 4.214; 95%CI = 1.894–9.373; P < 0.001). Conclusion: Compared to existing literature, Indians have a higher rate of clozapine- related seizures and need lower doses to reach therapeutic serum levels. [ABSTRACT FROM AUTHOR]

2017; 11: 48. 3 Mental Health Care CMHA and MHRB Rules 2018, Mental Health Care CMHA and MHRB Rules 2019, https://main.mohfw.gov.in/sites/default/files/Mental%20HealthCare%20CMHA%20and%20MHRB%20Rules%202018%5f0.pdf (accessed October16,. Dear Sir, The Mental Health Care Act, 2017[1] is amongst the most progressive legislations espousing a rights-based approach to mental health care.[2] The vehicles of MHCA include the Mental Health Review Board (MHRB), State Mental Health Authority (SMHA), and Central Mental Health Authority (CMHA). Such terms of reference would provide a clear construct within which the MHRB could function - this would help clarify when the MHRB could take I Suo moto i (on its own) cognizance. [Extracted from the article]