Psychiatric polypharmacy is common and carries real risks — QTc prolongation, metabolic syndrome, and drug-drug interactions. Clinit automates the safety checks that protect patients and clinicians.
Why Psychiatric Prescribing Is High-Risk
Psychiatric medications are among the most complex in outpatient medicine. Antipsychotics prolong QTc. Clozapine requires weekly blood counts. Lithium has a narrow therapeutic window with renal and thyroid consequences. Many patients are on combinations of antidepressants, antipsychotics, mood stabilisers, and anxiolytics — each interaction adding risk.
QTc Monitoring
When an antipsychotic is prescribed, Clinit flags the QTc risk level of the drug (low, moderate, high based on CredibleMeds classification). If the patient is already on another QTc-prolonging drug, the system triggers a warning and suggests a baseline ECG before initiation.
For patients on haloperidol, quetiapine, ziprasidone, or any high-risk agent, the medication record displays the last recorded QTc value and the date. If it's more than 3 months old, an amber badge prompts the clinician to order an updated ECG.
Clozapine Monitoring
Clozapine prescribing activates a mandatory monitoring schedule:
- Week 1–18: weekly FBC (absolute neutrophil count ≥2.0 × 10⁹/L required to continue)
- Week 19–52: fortnightly FBC
- After 1 year: monthly FBC
Each FBC result is entered in the clozapine sub-record. The prescription is locked until the current week's FBC is recorded and within range. Non-compliant results generate an immediate alert.
Second-generation antipsychotics (olanzapine, clozapine, quetiapine) carry significant metabolic risk. Clinit tracks:
- Weight and BMI at each visit (trend chart)
- Fasting glucose and HbA1c (with overdue alerts at 6 months)
- Fasting lipid panel (overdue alert at 12 months)
The metabolic dashboard for each patient shows all four parameters with their most recent values and status (normal / borderline / abnormal).
Lithium Monitoring
Lithium activates a monitoring schedule for serum lithium levels (target 0.6–1.0 mmol/L), eGFR, and TSH. Values are trended over time. The system alerts when the lithium level is above 1.2 mmol/L — the threshold at which toxicity becomes a clinical concern.
