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Article Abstract

Letter to the Editor

Sir: Clozapine continues to be the gold standard for patientswith treatment-refractory schizophrenia.1 However, when patientswho have responded to clozapine need to have clozapinetreatment discontinued due to a serious adverse event, such asglucose abnormalities, clinicians are often confronted with difficult choices regarding a suitable substitute treatment.

We present a patient who developed acute ketoacidosis while on clozapine treatment and who developed severe agitationand psychotic decompensation with subsequent aripiprazole treatment.