Letter to the Editor

Sir: Clozapine continues to be the gold standard for patients with treatment-refractory schizophrenia.1 However, when patients who have responded to clozapine need to have clozapine treatment discontinued due to a serious adverse event, such as glucose 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 agitation and psychotic decompensation with subsequent aripiprazole treatment.