CloZAPine Contigencies in 10,000 words by Keith “Buster” Torkelson, MS

 

Executive Summary

>This report pertains to the lived experience of Keith “Buster” Torkelson, MS.  It addresses his behavioral health from 1989 to the present.  Keith (B. 1959) is coming up on his birthday.  His calendar age will be 67.  As of March 2026, his Sharecare RealAge is 70Y09M.  Since Keith has been in treatment, he has had more than 240 CloZAPine (medication) related Complete Blood Counts (CBCs).  His results generally indicate normal or elevated Neutrophils, which, in Keith’s case, is protective.  Since 1989, Keith has been on more than six (6) anti-psychotic medications.  Some others were used off-label, including some anti-epileptics such as Topamax and Neurontin.  When his providers score his Mental Status Exam (MSE) Keith usually gets a perfect score.  Since 1989, Keith has been prescribed more than 15 psychotropic medications.  One of his key doctors was Ravinder P. Singh (RPS).  Dr. RPS earned a score of 3.5 out of 5 (with 5 being the best) with 2 online reviews (RateMDs - March 18, 2026).  Dr. RPS and Dr. David Dobos were Keith’s best psychiatrists.  Keith has approximately 19 outstanding health issues.  He is currently prescribed CloZAPine.  Since 2024, he is down from 200 mg of CloZAPine per night (divided doses) to 150 mg.  In this study, we feature another consumer taking CloZAPine.  Finally, since 1989, Keith has retained more than 14 psychiatrists.  With the psychiatrist shortage the way it is, Keith feels lucky to have the one he has. His current psychiatrist is Rimal B. Bera, MD.

 

Introduction – Keith Says…

>CloZAPine for me is indirectly essential for my survival.  My name is Keith “Buster” Torkelson, and I have been treated for behavioral health issues since 1989.  I have taken CloZAPine since 2006.  I am currently prescribed several medications that have activity in my central nervous system (brain).  One of them, CloZAPine (not Klonopin), is at the core of my 2026 treatment plan.  Here in this paper we discuss numerous medications with a concentration on CloZAPine.  Some keywords for this study are: Contingency, Treatment Plan, Doctor(s), and Risk.  Most of this information is a product of lived experience (LE).  The purpose of this work is to disseminate intelligence regarding our case while ferreting out fixes to some of our concerns. 

 

Presenting Problems with Psychotropic Medications

Presenting problems with psychotropic medications often involve adverse effects such as sedation, weight gain, metabolic syndrome, sexual dysfunction, and movement disorders (extrapyramidal symptoms). Patients frequently report "feeling not like myself," cognitive issues, and withdrawal symptoms. Common issues include daytime sleepiness, nausea, headaches, and in severe cases, serotonin syndrome, or suicidality.

 

Adverse Effect Sedation is desirable

Sedation is commonly utilized as a therapeutic tool to manage anxiety, ensure patient compliance, and reduce pain during procedures, making it a desirable effect in acute clinical settings like surgery or intensive care (ICU). While often considered a negative side effect of psychiatric medications, sedation is essential to keep patients calm, immobile, and comfortable during stressful interventions.

 

Aspects of Interest

 

CloZAPine Contingencies
Dependence on Clozapine
Reduced chance of Neutropenia
Mandatory CBC test requirement lifted

 

Associated Studies

 

01_Plan_Px_Early-Warning_14112504 V2026
08_LS_Lighthouse_16060703_Tracker V2023

 

Reference Documents (Partial)

 

CloZAPine Practical 1.0_28_Day_Cycle_17012005 V2026
Clozapine Practical 7.3_Algorithm_17042902 V2026
PHR_Xeno_4.0.1_Medication_History_17121101_Develop RBB V2026
QIP_OM_MSE_Actual_11011202 V2026
10_BMB_Profile_15110603_Psychiatrists V2026
QOL_Helpers_Un_Natural_Support_Case_Managers_25030901_Assess V2026
08_LS_BND_CCCHC_BSL_Sam_I_Am_18092702_Clozapine V2026

 

Outline/Contents

 

• Summary & Introduction
• Openers – Brain Imaging
• Aging
• Contingency Notes
• FYI – CloZAPine
• Adverse Reactions
• Neutropenia
• History of CBCs
• CloZAPine is not Klonopin
• Challenging Medications
• CloZAPine Algorithm
• History of Doctors - Partial
• History of Medications
• 2006 Nexus – Ravinder P Singh MD
• Compare DRC with DMD
• Mental Status Exam (MSE)
• MSE Brief – Student Helper
• 2025-2026 Undocumented
• Sample Summary of Today’s Visit
• Sleep Coping
• Sleep Associated Strengths
• Conclusion

 

 

Subject

This report pertains to Keith “Buster” Torkelson, MS

 

When to stop studying a topic?

Stop studying a topic when you can confidently explain the core concepts in your own words, consistently achieve your target score on practice tests, or when you feel significant mental fatigue. Other indicators include achieving your set time limit, grasping the main ideas (See Outline), and recognizing that further review brings diminishing returns.

 

When to wrap up your report?

Wrap up your report when you have restated the main objective, summarized key findings, and addressed the questions raised in the introduction. A strong conclusion should provide closure without introducing new data, often including actionable recommendations or a final thought that highlights the significance of the findings.

 

Core Concepts

Core concepts are the fundamental, "big ideas" or foundational principles that define a discipline, enabling deeper understanding and the ability to transfer knowledge across different topics. They act as a framework to organize content, facilitate critical thinking, and allow for the application of knowledge to new situations.

 

Main Objective

>The primary goal with this study is to condense our medication management education and experience for others to benefit. This study primarily pertains to CloZAPine a psychotropic drug. 

 

Foundational Principles of Medication Management

Foundational principles of medication management ensure safe, effective, and patient-centered care through the "rights" of administration (patient, drug, dose, route, time, and documentation), regular comprehensive reviews, and careful monitoring for adverse effects. Key practices include preventing errors, maintaining clear communication, ensuring proper documentation, and fostering collaboration between patients and providers to optimize therapeutic outcomes.

 

Foundational Principles of Risk Management

Foundational principles of risk management involve a systematic, proactive process to identify, analyze, evaluate, and treat uncertainties that threaten objectives. Key principles include embedding risk management into all processes, maintaining a continuous monitoring cycle, engaging stakeholders, and making informed decisions to create value.

 

Key Findings

• I am better prepared to negotiate with a new roommate.
• I am highly dependent on sleep.
• It is prudent to stick with the current (2026) Treatment Plan
• It is unlikely that my Neutrophils will drop to Neutropenia.
• It was a wise decision to stop drinking caffeinated coffee.
• No matter what it is, if it helps me sleep, I will be dependent on it.
• Room 207 above me will periodically wake and keep me up in the middle of the night.
• The nighttime medications I am on are sufficient.

 

Questions

• Am I being appropriately served?
• Can I change the potentially annoying things that I do?
• In the CT scan what am I seeing?
• Is there a better pharmacological solution to my sleep disorder?
• What can I do about the person(s) in 207 above me?
• What will the roommate replacement be like if we negotiate?
• Will my medication support structure suffer any gaps?
• Will this report help my advocate adequately know my situation?

 

Actions – Behaviors

 

• Finish this paper
• Publish this paper
• Share this paper with my helper(s)
• Promote this paper via Twitter
• Routinely pray that we will get a great matching roommate

 

Feature Image (20180607-Keith Torkelson) - Asymmetric

Assymetry of the brain

Brain asymmetry refers to structural and functional differences between the left and right cerebral hemispheres, with the brain exhibiting a general leftward posterior/rightward anterior ("torque") pattern. Key specializations include left-hemisphere dominance for language and motor skills, while the right hemisphere specializes in spatial processing. This lateralization is crucial for efficient, parallel processing and is present throughout the animal kingdom.

 

Key Aspects of Brain Asymmetry

Anatomical Asymmetry: The human brain is not perfectly symmetrical. The left occipital and right frontal regions tend to protrude, a pattern known as cerebral petalia. Key structural asymmetries exist in the Heschl gyrus, Sylvian fissure, and temporo-parietal regions.

FYI - Brain Aging

https://www.spring.org.uk/2018/08/disorders-brain-damage.php

Largest ever study of its type reveals the disorders that accelerate brain aging.

Schizophrenia, cannabis abuse and bipolar disorder accelerate brain aging the most, new research finds. Schizophrenia ages the brain by an average of 4 years, cannabis abuse by 2.8 years and bipolar disorder by 1.6 years.  Fifth on the list, behind ADHD, was alcohol abuse, which ages the brain by an average of 1.4 years. Depression and anxiety, however, were not linked to any premature brain aging.

 

ShareCare Realage

Sharecare RealAge is a scientifically based health assessment that calculates the physical age of your body compared to your calendar age based on lifestyle, genetics, and medical history. It is the foundation of the Sharecare platform which provides personalized insights, daily tracking, and targeted programs to help users reduce their health risks, lower their RealAge, and improve overall well-being.

 

RealAge

Matrix – ShareCare RealAge Online Assessment Results

Last Update: 20260317-TU: For Keith Edward Torkelson, M.Sc.

CA=Calendar Age | RA=RealAge | RAOA=RealAge Online Assessment

https://you.sharecare.com/you/score

Health for a 70 year old male

For a 70-year-old male, key health focus areas include maintaining muscle mass with higher protein intake (1.0-1.3g per kg of body weight), regular aerobic exercise (150+ minutes/week), and strength training to manage weight and heart health. Prioritize screenings for cardiovascular health (blood pressure, cholesterol), prostate/colorectal cancer, bone density, and hearing.

 

Behavioral Health for a 70 year old male

Behavioral health for a 70-year-old male involves addressing common risks like depression, anxiety, isolation, and cognitive decline through a combination of tailored psychotherapy (CBT/ACT), medication management, and social engagement. Effective strategies include maintaining a regular routine, physical activity, and utilizing resources like a Friendship Line.

 

Resilience of Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) effectively builds and sustains psychological resilience by teaching individuals to challenge negative thought patterns, manage emotions, and adopt proactive coping strategies. Studies show CBT significantly enhances resilience post-intervention and maintains these improvements over time, aiding in adaptation to stress, trauma, and chronic illness.

 

How long do the benefits of CBT last?

Cognitive Behavioral Therapy (CBT) benefits are designed to be long-lasting, often providing tools that prevent relapse for years after treatment ends. Studies show that improvements, particularly for anxiety and depression, are maintained over the long term, with some benefits persisting for 10 to 20 years, as noted by research from PubMed.

 

Four months of intense daily CBT

Four months of intense daily Cognitive Behavioral Therapy (CBT) represents a highly focused, accelerated approach to mental health treatment, often used for severe anxiety, OCD, or depression. Unlike standard weekly therapy, this format is designed to produce significant improvements in a shorter timeframe by packing months of work into weeks or days, often requiring several hours of daily commitment.

 

Clozapine Related History & Notes - Work Done

April 2019 - Brand New Day HMO – We Called Him Sam I Am!

http://brandnewdayhmo.blogspot.com/2019/04/

Emerging Health Risks for Keith “Buster” Torkelson

Introduction – CloZAPine Contingency Study

>If our New & Improved Behavioral Health Doctor (BHD) had been more amenable during our “Crash Appointment,” he would have discovered how and why we wanted some tweaking of our 3 medication “Cocktail”: CloZAPine, Lithium, and Lorazepam.  We were going to tell him why we want our Lorazepam (PRN) periodically exchanged with the generic for temazepam, the generic for Restoril.  In addition, we wanted to develop a backup plan for CloZAPine.  In 2012, we were instructed by Dr. Daniel that she could do better for us by eliminating and replacing our mainstay CloZAPine.  The medication she prescribed us did not help us as CloZAPine did.  With this decision (experiment), she broke our CloZAPine continuity.  We did not sleep and ended up in the hospital.

 

“Tell it to your friends” (& family)

>As a result of no CloZAPine, we stayed up sleepless for three nights.  We went “Wakko” and ended up (back) on the Western Med Anaheim (WMA) Psych Ward, where we met Dr. Bum Soo Lee, MD (BSL).  We are dependent on CloZAPine for our nightly sleep.  Without it, we do not sleep.  We have/had a friend at Brand New Day (BND), our insurer and “program”.  We call him Sam I Am!  As of 2018, Sam had been “Stable” on CloZAPine for more than 2 decades.  In 2018, Sam had some poor CloZAPine related lab (Complete Blood Count) results.  The test indicated he had Neutropenia.  In response, his doctor took him cold Turkey off CloZAPine.  One week later, he hadn’t slept.  Later, we are going to discuss Sam a bit further because his case is remarkable. As of 2019, Sam is Missing in Action (MiA).

 

Improving Partnership

In 2012, while in the hospital without CloZAPine, the doctor BSL approved for us Restoril to sleep.  It was nearly as effective as CloZAPine.  Lorazepam for us cannot substitute for CloZAPine for our sleep needs.  We explore other options in this paper.  The OC Health Care Agency (OC HCA), for whom we partner (2009-2026), would call delivering on our Restoril request part of our personalized Safety Net.  At the “Crash Appointment,” the doctor. Rimal B. Bera (RBB) indicated he would not listen to us!  RBB said, “Tell your friends about it”.  We think he meant our friends at the OC HCA.  Things with RBB have improved since the Crash Appointment, especially since we graduated in 2024 out of skilled nursing.  With mutual input, we have created and put into effect a collaborative treatment plan. It is in alignment with our insurer's treatment plan.

 

Work Done
2018 - CloZAPine RX 4 Ecstasy- Featuring “Sam I Am”
http://clozapinerx4ecstasy.blogspot.com/2018/
Sep 28, 2018

Vignette - Here Is The News! – CloZAPine Risk & Contingency

As we write this paragraph, it is June 26, 2018.  We will carry this paragraph through multiple publications because we find it remarkable, timely, and thus important.  There is an issue with our primary medication, CloZAPine, for which we have no tangible fix.  Today, while at the clinic, Central City, for our routine Complete Blood Count (CBC) work, we overheard another consumer (patient), Sam I Am, sharing in the waiting room.  Sam reports that after being rather stable on Brand-name Clozaril (Generic CloZAPine) for over twenty (20) years, his CBC lab number became critical.  More clearly, he is now suffering low numbers of White Blood Cells (WBCs).  Most likely, it is his Neutrophils in the WBC family that are low.  This is Neutropenia.  Bad news!  Neutropenia indicates that you cannot be prescribed Clozaril (CloZAPine) anymore.  We will leave his “doctor” anonymous. 

 

Contingencies Needed

>In response, “doctor” stopped Sam I Am’s Clozaril cold turkey while they waited for a second lab to confirm the problem.  Sam reports he has not been sleeping because Clozaril is essential for a full, restful night of sleep.  When we left him about 11am, we wished him luck because the lab and his Clozaril disposition are pending.  Sam is quite bright when it comes to how much he has learned as a Behavioral Health Consumer (BHC).  He said that a relative said why not reduce the Clozaril rather than take it away cold turkey.  Furthermore, the relative advises that on a reduced dose, he might get the benefit of sleep and get his WBC number(s) up again.  For us, also on CloZAPine, we have worried quite a bit about a life without CloZAPine.  Actually, in 2012, we suffered catastrophic losses, and CloZAPine was in the scenario.  As Sam puts it, Clozaril was a real game changer for him.  We agree, for us CloZAPine has been a game changer.  In the next paper (actually, this paper), we will address what we call our CloZAPine Contingencies.  This puzzle should be offered to Medical students in their Pharmacology Course because good “fixes” without CloZAPine are in need.

 

FYI – CloZAPine

Adverse Reactions to CloZAPine

CloZAPine is a highly effective antipsychotic with a distinct side effect profile requiring mandatory blood monitoring due to risks like agranulocytosis (critically low white blood cell count). Common side effects include sedation, hypersalivation (drooling), constipation, tachycardia, and weight gain. Serious, immediate-care side effects include fever, seizures, severe constipation, and chest pain.

 

Neutropenia AKA Agranulocytosis

Agranulocytosis is a severe, life-threatening form of profound neutropenia, often defined as an absolute neutrophil count (ANC) <100 cells/microliter, whereas general neutropenia covers a broader range. It is characterized by an almost total absence of neutrophils—vital infection-fighting white blood cells—leaving the body extremely vulnerable to infections.

 

Neutrophilia - Protective

High neutrophils (neutrophilia) typically mean your immune system is responding to infection, inflammation, or stress, with acute bacterial infections being the most common cause. Other causes include smoking, tissue damage, medications, and rarely, bone marrow disorders. Treatment focuses on the underlying cause, often requiring antibiotics, medication adjustments, or monitoring.

 

History of Complete Blood Counts (CBCs)

>Since 2006 we have had more than 240 CBCs.  We never missed a single CBC.  With respect to our Neutrophils we have always tested normal or elevated.  In our case elevated Neutrophils are protective.  We are due for our next CBC with our pre-physical March 23, 2026.  As mentioned later “the Registry” does not require CBCs anymore.  We figure two times per year would be prudent.  This aligns with the work Central City wishes to perform.

 

History - Longitudinal Snapshot – WBCs and Absolute Neutrophils

Lab = Quest Diagnostics

Retire - 28 Day Cycle - Calendar Graphic Organizer (GO)

>Our new insurance, CalOptima, has been good at authorizing our PCP and specialist services.  Below is a graphic that demonstrates that lifting the CBC rule (See below) is better for the consumer.  We, as consumers, were educated about CloZAPine, stressed over our Neutrophils every month, as did Sam. Prescribing 30 days’ worth every 28 days provided a safety factor. This GO was from when Brand New Day (BND) was our insurer.  Now that the CBC rule has changed, consumers do not have to stress so much about the CloZAPine process.  BND (Bright) created a gap, yet we had it covered because we had back-up CloZAPine

Routine 28-day CloZAPine Cycle

>As of 2024 June 20 Keith lives in a retirement (assisted living) facility.  They, the med staff, have had more than a year to overcome any medication gaps.  So far 2026 March 14 we have suffered no gaps in medication.  That is more than 12 months with no errors. SF = Smile Face.  Currently, the pharmacy, Gilbert Drugs, delivers every 30 days.

 

FYI - Coordination of CBCs and CloZAPine – Old School

CloZAPine requires mandatory, structured blood monitoring to detect neutropenia (low neutrophil count), which can lead to life-threatening agranulocytosis. Patients require a baseline Absolute Neutrophil Count (ANC) >= 1,500/microliter before starting, with weekly monitoring for the first 18 weeks, followed by biweekly and eventually monthly tests, according to standard guidelines.

 

Mylan Registry

Mylan (now Viatris) provides a dedicated, secure, and confidential patient registry and monitoring database for its cloZAPine products—specifically Gen-CloZAPine—often accessed via the GenCAN (Gen-CloZAPine Access Network) to manage mandatory blood work (ANC monitoring).

 

Teva Registry

Teva CloZAPine patients must be enrolled in the centralized CloZAPine REMS Program. This FDA-mandated Risk Evaluation and Mitigation Strategy (REMS) ensures mandatory monitoring of absolute neutrophil counts (ANC) to prevent serious neutropenia. Patients must have baseline and regular blood tests to receive medication.

 

REMS Removed (:o)) – Rule Lifted

Effective June 13, 2025, the FDA removed the Risk Evaluation and Mitigation Strategy (REMS) for cloZAPine, eliminating the mandatory, centralized registry for tracking patient blood work. Previously, this registry enforced strict, mandatory Absolute Neutrophil Count (ANC) monitoring to prevent severe, fatal neutropenia (agranulocytosis).

 

CloZAPine is not Klonopin

>CloZAPine is often mistaken for Klonopin. This is why you will observe the “zap” as ZAP.  CloZAPine and Klonopin (clonazepam) are two completely different medications that cannot be substituted for each other. CloZAPine is an atypical antipsychotic used to treat severe schizophrenia, while Klonopin is a benzodiazepine used to treat anxiety and seizure disorders. Confusing them can lead to serious risks.

 

Antipsychotic Meds We Have Tried

 

• Haloperidol (Haldol®)
• Thiothixene (Navane®)
• Risperidone (Risperdal®)
• Olanzapine (Zyprexa®)
• Quetiapine (Seroquel®)
• Aripiprazole (Abilify®)
• Fluphenazine (Prolixin®)

 

Anti-psychotic, Anti-bipolar

Commonly used antipsychotic medications are categorized into first-generation (typical) and second-generation (atypical) types, chosen based on symptom profile and side-effect tolerance. Key medications include risperidone (Risperdal), quetiapine (Seroquel), olanzapine (Zyprexa), aripiprazole (Abilify), ziprasidone (Geodon), and clozapine (Clozaril). They treat schizophrenia, bipolar disorder, and sometimes severe anxiety by managing dopamine and other neurotransmitters.

 

Other psychotropic medications we’ve tried

 

Antidepressants (SSRIs/SNRIs/Others)

• Sertraline (Zoloft®)
• Bupropion (Wellbutrin®)
• Venlafaxine (Effexor®)

 

Key 2025 Guidelines & Resources

CMS Regulations: Updated guidelines often emphasize cautious use of antipsychotics in elderly populations. CMS updated surveyor guidance effective April 28, 2025, significantly tightens restrictions on antipsychotic and psychotropic medication use in nursing homes (F605, formerly F758), emphasizing informed consent and reducing chemical restraints. The updates focus on eliminating use for staff convenience, enhancing resident autonomy, and strengthening audits to prevent unnecessary medications

CloZAPine Algorithm

>From 1989 till 2006, Buster was tried on just over a half dozen anti-psychotic medications: Haloperidol (Haldol), Risperidone (Risperdal), Olanzapine (Zyprexa), Quetiapine (Seroquel), Aripiprazole (Abilify), Etc.  The algorithm below indicates that he was long overdue in 2006 for being challenged with CloZAPine.  Dr. RP Singh ran the experiment and was the prescribing doctor.

 

Benefits

CloZAPine is the most effective antipsychotic for treatment-resistant schizophrenia (TRS) and reducing suicidal behavior. It significantly improves psychotic symptoms (hallucinations, delusions), lowers hospitalization rates, and treats tardive dyskinesia. It also offers better cognitive function, mood improvement, and enhanced quality of life for patients.

 

Number of people treated with CloZAPine

CloZAPine, used for treatment-resistant schizophrenia, has low global utilization due to strict monitoring requirements, despite its high efficacy. Approximately 37,000 people are prescribed it in the UK, while use in the U.S. is under 4% of schizophrenia patients, indicating significant underutilization. While effective in 2 out of 5 patients with treatment-resistant schizophrenia, its use is hindered by risks like severe neutropenia, which affects 1 in 7,700 patients, says a study from STAT News.

 

How many people have schizoid diseases in the United States?

Schizoid personality disorder (SPD) affects approximately 1% to nearly 5% of the general population in the United States, according to various estimates. It is relatively uncommon, often characterized by social detachment, limited emotional expression, and a preference for solitary activities, with a slightly higher prevalence in men.

 

How many people have schizophrenia in the United States?

Approximately 1.2% to 1.8% of U.S. adults (roughly 3.7 million people) are estimated to have schizophrenia spectrum disorders, with studies suggesting it is more common than previously thought. Other sources indicate at least 1 in 100 people, or roughly 2 million adults, in the U.S. have these disorders.

 

What causes psychosis?

Psychosis is caused by a complex interaction of genetic, biological, environmental, and physical factors that affect brain chemistry, particularly by increasing dopamine activity. Common causes include severe mental illnesses (schizophrenia, bipolar), extreme stress, trauma, substance misuse (cocaine, cannabis), and certain medical conditions.

 

What are the risk factors for psychosis?

Risk factors for psychosis include genetic predisposition, trauma (especially in childhood), and substance abuse (notably cannabis). Environmental factors like growing up in urban areas, migration, social isolation, and early life complications (e.g., prenatal infections) can also trigger psychosis.

 

Whether Bipolar, Schizoid or Anxiety what we have done

History of Doctors – Partial

>The following is a table that lists the majority of Buster’s psychiatrists (MDs) and, when available, their working diagnoses.  Doctor Dobos at Kaiser did the best with history taking.  In addition, he tried us on the most different medications.  Our current treatment is built on the progress each doctor made with us before them.  The table is organized alphabetically rather than chronologically.  Most of our doctors do not care to hear about how their predecessors treated us.  Sometimes they think that Buster is seeing more than one psychiatrist.  We know a few consumers (clients) who do see multiple psychiatrists.

The Motivation to see more than one psychiatrist

Motivations for seeing more than one psychiatrist often include seeking a second opinion for complex conditions, specialized care (e.g., separating medication management from therapy), or lack of progress with a single provider. It may also stem from a desire to "shop" for a better rapport, manage mistrust in one clinician, or cope with extreme anxiety, according to users on Quora and Reddit forums.

Doctor Cipher

Name	Initials	Diagnosis	Note
Alan Vu	AxV	Situational	Associated with a hospitalization
Andrew Inglis	AxI	Schizoaffective	Graduated us after 1 year
Arnold P Deutsch	APD	Revised De Silva	Declares the Hospital “Overmedicated” Me
Belman (WTRC)	xxB	UD
Bum Soo Lee	BSL	Bipolar – Revised Singh	Put us back on CloZAPine
Clayton Lon Chau	CLC	Never made one	Not involved in treatment plan A consumer survivor
Daniels (ALH)	xxD	Substance Use Disorder	RX History Issues Revised Singh Fails with Invega
David M Dobos	DMD	Major Depressive Disorder	Improvement with Seroquel
David Royce Chandler	DRC	UD	Error with Ambien
Graham and Dean	xxD & xxG	Gravely Disabled - Unspecified	Experimented with Me Declare causes are not important
Himasiri K De Silva	HKDS	Bi-polar	Bi-polar 1989 Not a good match Again Bi-polar 2016
Helen Krell	HxK	UD	In Davis
Ravinder P Singh	RPS	UD	2006 challenged us with CloZAPine
Rimal B Bera	RBB	Bipolar I	Keeping me on cloZAPine, lorazepam and Ambien
Scott Lambert	SxL	UD
Wardel	xxW	UD	No medication prescribed

Last Reviewed: 20260314-SA: UD = Undocumented

 

Consumer-Survivor

The consumer-survivor movement is a human rights movement composed of individuals with lived experience in the mental health system, aiming to empower patients and challenge coercive practices. "Consumers" often seek to improve existing services, while "survivors" often take an anti-psychiatry stance, having survived harmful, involuntary treatment.

Brief History – Medical Record – For Keith Torkelson (28 Feb 2007)

Dr. Andrew Inglis MD

Why is it rewarding to go through your case history?

Going through your case history is rewarding because it acts as a "detective" tool to identify health, legal, or personal trends, enabling better advocacy and decision-making. It enhances medical care accuracy, connects you to your heritage, and provides psychological, therapeutic, and self-discovery benefits.

 

Key rewards include

 

Improved Health Outcomes

Documenting medical history helps track symptoms, medications, and hereditary risks, allowing for better diagnosis and tailored care. Documenting medical history is a critical component of modern healthcare that leads to significantly improved health outcomes by enabling precise diagnoses, safer treatments, and tailored care. By systematically tracking symptoms, medication regimens, and family health history, individuals and providers can identify patterns, manage chronic conditions more effectively, and prevent adverse events.

 

Empowerment and Advocacy

Knowing your history helps you communicate effectively with doctors, ensuring you receive the best care. Empowering yourself through proactive advocacy involves taking an active role in your health, ensuring you receive personalized, safe, and effective care. By organizing your medical history—including diagnoses, medications, and symptoms—you can communicate more effectively, reduce errors, and foster better relationships with providers.

 

Psychological and Emotional Well-being:

Reviewing personal or family history can be therapeutic, offering insights into identity, fostering a sense of belonging, and allowing you to heal.  Reviewing personal or family history is a therapeutic tool that strengthens mental well-being by fostering a stable identity, promoting a sense of belonging, and allowing for the healing of intergenerational traumas. Understanding family narratives helps individuals build resilience, process past events, and develop a sense of continuity that improves psychological resilience.

 

Strategic Insights

In professional or legal contexts, reviewing case histories helps identify patterns, such as uncovering crucial, seemingly unrelated facts that explain current circumstances. Reviewing case histories in professional and legal contexts is a critical strategic activity that moves teams from reactive to proactive, enabling them to identify patterns, and predict outcomes. By analyzing past decisions through data analytics and AI, professionals can identify successful tactics, avoid common pitfalls, and gain a competitive edge.

 

Problem-Solving

Case studies highlight principles, show cause and effect, and help you understand how to apply lessons to your own research or situations. Case studies are powerful, in-depth investigations of real-world scenarios—such as a specific person, group, event, or organization—that serve as a bridge between theoretical knowledge and practical application. They highlight principles by allowing for detailed, context-rich descriptions of complex situations, rather than relying on abstract, generalized data

 

How deep might you go?

Whether for medical, family, or professional reasons, digging into a case history helps you understand "where you've been" to better navigate "where you're going." Digging into a case history—whether medical, familial, or professional—is a foundational practice that transforms past experiences into actionable insights for future navigation. By understanding "where you've been," you can identify patterns, mitigate risks, and make more informed decisions.

 

Bipolar I

Bipolar I disorder is a serious mental health condition characterized by at least one manic episode, often alternating with major depressive episodes. Mania causes extreme, high-energy moods, impaired judgment, and sometimes psychosis, often requiring hospitalization. It is a chronic, treatable condition requiring lifelong management.

Differentiating Bipolar I from Anxiety Disorder

Bipolar I disorder is characterized by extreme mood swings—distinct periods of mania (high energy, euphoria, or severe irritability) lasting at least a week—and deep depression, whereas anxiety disorders involve persistent, ongoing fear or worry without the intense, cycling mood highs. Key differences include energy sources, duration of symptoms, and the presence of psychosis in mania.

 

Psychosis in Anxiety

Anxiety-induced psychosis is a temporary state where extreme stress or severe anxiety causes a person to lose touch with reality, resulting in hallucinations, delusions, or intense paranoia. Unlike chronic psychotic disorders, these episodes usually last only as long as the anxiety attack or stressor. It is typically treated through psychotherapy, anxiety management, and sometimes short-term medication.

 

Lab Testing for Mental Illness

While there is no single, definitive lab test to diagnose mental illness, blood tests, genetic testing, and metabolic panels are increasingly used to identify underlying causes, guide medication selection, and monitor treatment. Common tests evaluate thyroid function, vitamin levels (B12, D), and gene expression for tailored medication (e.g., GeneSight) or to measure biomarkers like those in the MindX Blood Test.

 

What we have done - History of Medications

Medication History & Costs - Quality and/or Category – Quality Grade

DOI = Date or Interval - Uncertain

Medication History

DOI = Date or Interval – Not perfect

DOI	DOI	Medication	MD Associations
1988	1988	Tylenol	Clark for Suspected Rabies' AR
1989	1990	Haldol/Haloperidol	Graman/Dean/APD
1989	1989	Klonopin	Krell, Helen
1989	2009	Benadryl (PRN)	1st in ER
1989	1989	Lithium carbonate	DeSilva
1991		Navane	Woodland Memorial & APD
1992	1993	Lorazepam	Jeik [SPELLING] (UC Davis)
1992	1993	Propanolol	Jeik
2000	2003	Melatonin (PRN)	Self OTC
2000	2003	Valerian (PRN)	Self OTC
2000	2003	Saint john's wort (PRN)	Self OTC
2001		Serzone	Dobos, David
2003	2008	Seroquel	Start by Dobos
2003	2003	Viagra	Dobos – Associated with a DUI
2004	2005	Ambien	Chandler, David (*)
2004		Topomax	Dobos, David
2004		Wellbutrin	Dobos, David
2006	2006	Restoril	Singh & Bellman & Lee
2006	Present	CloZAPine	Singh/Leno/Inglis/Vu/BSL/Bera
2006		Depakene/Depakote	Chandler, David
2006		Choline (PRN)	Self OTC
2006	2006	CloZAPine	Singh, Ravinder P
2006	2007	CloZAPine	Dr. Belman
2007	2012	CloZAPine	Vu, Alan
2009	2011	Risperidone	Vu, Alan
2012	2017	Ativan (PRN)	Bum Soo Lee (BSL)
2012	2012	Seroquel	Lee until CloZAPine could be reestablished
2012	2012	Invega	Daniels Associated with hospitalization
2012	Present	CloZAPine	2023 Dr. started looking into alternatives
2012	2012	Invega	Waknine > BSL (Ineffective BSL discontinued)
2012	2017	CloZAPine	BSL & Meier
2012	2017	Lithium	BSL
2012	2017	Lorazepam	BSL (Retires 2017)
2018	2026	Lithium	Rimal B. Bera (RBB)
2018	2026	Lorazepam	2024 RBB down to 1mg/day from 4mg/day (Leisure)
2018	2024	CloZAPine	RBB
2018	2024	Lithium	RBB
2018	2024	Lorazepam (PRN)	RBB
2018		Melatonin (PRN)	Self – Response to Sam I Am (Vignette) Uneasy about CloZAPine
2023	2024	CloZAPine	RBB has gap for alternative trials
2024	2024	Restoril/Temazepam	Leisure Doctor
2024	2024	Trazadone	Leisure Doctor (Ineffective)
2024	2024	Ativan	Leisure Doctor
2024	2024	Invega Sustenna	Global > Leisure > Rimal B. Bera (RBB) discontinued due to ineffective and adverse reactions

Medication - Xenobiotic

A xenobiotic is any chemical substance found within an organism that is not naturally produced, expected to be present, or nutritive, including most medications, environmental pollutants, and industrial chemicals. Drugs, such as antibiotics, are considered xenobiotics because they are foreign to the body's normal metabolism, requiring detoxification for excretion

 

How many psychotropic medications should you try before using CloZAPine?

CloZAPine is typically initiated after the failure of at least two adequate trials [experiments] of different antipsychotic medications. A failed trial is defined as 6–8 weeks of treatment at a therapeutic dosage without significant improvement in psychotic symptoms.

 

FYI - CloZAPine Availability

Why wasn’t I treated with CloZAPine earlier?

Clozapine is often delayed due to its "last resort" reputation, stringent FDA-mandated weekly blood monitoring (REMS), and potential severe side effects. While highly effective for treatment-resistant psychosis, clinicians may delay it due to patient monitoring burdens, fears of side effects, or waiting to try other medications.

 

2006 Nexus – Ravinder P Singh MD

>Dr. Singh started us on our journey of setting things right with CloZAPine.  She also encouraged us to do some work with our boundaries.

 Ravinder Singh, MD - Updated March 2026

 

Yelp

Doctors > Psychiatrists

Ravinder Singh, MD, 12555 Garden Grove Blvd. Suite 305, Garden Grove, CA 92843, (714) 537-7722

20260314 1.4 Stars from 5 (Yelp) Reviews

20260318 3.4 Stars from 10 (Google) Reviews

We give Dr. Singh 5 Quick Stars

 

Dr. Singh

Dr. Ravinder P. Singh is a psychiatrist in Garden Grove, California and is affiliated with multiple hospitals in the area, including Anaheim Global Medical Center and Providence St. Joseph Hospital-Orange. She received her medical degree from Government Medical College Patiala and has been in practice for more than 20 years. She has expertise in treating bipolar disorder, among other conditions.  Dr. Ravinder P. Singh accepts Aetna, Blue Cross - see other insurance plans accepted.

 

Why rate your doctor?

Rating your doctor helps other patients make informed decisions, highlights the quality of care and communication, and provides feedback on office efficiency, such as wait times and staff friendliness. These reviews (e.g., on Healthgrades, Vitals) help prospective patients find the right provider, with 35% of patients choosing doctors based on good ratings

 

Aside - Compare DRC with DMD

>We saw Dr. Chandler (DRC) for two intervals and we saw Dr. Dobos (DMD) for two intervals.  At the time Dr. Chandler was the service chief executive psychiatrist with Kaiser.  On 20160410 we scored both retroactively.  On our low weight assessment DRC earned 12.5% and DMD earned 83.3% with high scores being favorable.  On our high weight assessment DRC earned 30.8% and DMD earned 57.7% with high scores being favorable.  Dr. DMD and Dr. Singh are our two best (A+) psychiatrists.

 

Causes of Mental Illness

Mental illness rarely has a single cause, stemming instead from a complex interplay of genetic, biological, environmental, psychological, and social factors. Key drivers and risk factors include inherited genetics, brain chemistry imbalances, childhood trauma, chronic stress, social isolation, and substance abuse. These risk factors can interact to trigger conditions like anxiety, depression, and schizophrenia.

 

Causes of Mental Illness (Partial)

 

Abuse
Biology & Brain chemistry imbalances
Childhood trauma
Chronic illness & Chronic stress
Environment
Inherited genetics
Poverty
Psychological factors
Risk factors
Sleep problems
Social isolation
Substance abuse

 

Is sleep a risk factor for mental illness?

Yes, poor, insufficient, or disrupted sleep is a major, independent risk factor for developing and worsening mental illnesses, including depression, anxiety, and suicidal ideation. It operates in a bidirectional relationship where poor sleep can trigger mental health disorders, which then cause further sleep issues, creating a dangerous cycle.

 

Mental Status Exam (MSE)

>We first ran into the Mental Status Exam (MSE) with Dr. Inglis (2007) while he was working at the Orange County Health Care Agency (OCHCA), Costa Mesa Clinic.  On at least two occasions, he gave us a perfect 100% MSE score.  Below we include Dr. Inglis report, then our rendition of the MSE with results for us.  Below is the source for the 12-item version.

20260105-M: MSE Modified Scoring

>We periodically run our Brief Mental Status Exam (MSE) Form 16-Item.  For the purposes of reporting we extend the 12 item version into a 16 item version.  We prepare this for our routine medication management appointment.  Before seeing Dr. (RBB) his student collects partial MSE related information.  It is primarily used to detect if the patient is dangerous or in need of hospitalization.  The results below pertain to Keith “Buster” Torkelson, MS.  Doctor used to report on his MSE findings.  For this MSE higher scores are favorable (HSF).  The assessment was scored in Real Time (RT).  TC = Thought Content.  We use our Binary Plus Scoring Method: | 1.00 = Yes | 0.00 = No | 0.50 = SoSo.

MSE for Keith “Buster” Torkelson, MS

Last Reviewed: 20260317-TU:

 

MSE Brief – Student Helper

>Doctor Bera is associated with UC Irvine (UCI) Medical School.  On the majority of our appointments, he has one of his students triage us.  Before the appointment, his student offers a truncated version of the MSE.  From their interview, they can determine if a client needs to go to the hospital.  We have always passed their evaluation.  We don’t have any data from MSE’s evaluated while in the hospital.  We’ve seen “doctor” (RBB) for more than 5 years.  In the beginning, RBB would perform the MSE evaluation and include it with our Visit Summary.  More recently, he does not include his MSE findings in the Visit Summary.

Global Health - Sample from “Summary of Today’s Visit”
Central City Community Health Center - July 9, 2025 (W)
Problem List – LSF = Low Scores are Favorable | RT = Real Time

##	Problem	2025 0709 W-RT For KET	Status & Impact
01	Actinic Keratosis	0.50	Routine cryo treatments
02	Age-related nuclear cataract	0.00	Had surgery
03	Alcohol dependence, in remission	0.50	Remission reported
04	Allergic rhinitis	0.00	Resolved
05	Bipolar 1 disorder	0.50	Current working diagnosis
06	Cataract of left eye [DITTO]	0.50	Resolved
07	Cigarette smoker	0.75	Compared with 1 year ago down by half of cigarettes per day
08	Hearing loss	0.50	ENT cleared left ear – hearing improved
09	Hyperlipidemia	0.00	Controlled with Atorvastatin [SPELLED]
10	Impotence	0.50	Of less significance with age
11	Leukemoid reaction	0.00	Protective
12	Medical Exam without abnormal findings	0.00	Good
13	Other chronic pain	0.50	Resolving
14	Other not elsewhere	1.00
15	Primary insomnia	1.00	Treatment plan is working
16	Schizoaffective disorder, bipolar type	0.50	Uncertain
17	Smoker’s cough	0.25	Improved
18	Vision problem	0.50	Dependent on glasses Distance vision improved
19	Wart	0.25	Old ones resolved – have a new one
	CALC	=7.75/19
	Health Problem Impact Score (LSF) =	40.8%

Sleep Coping

To improve sleep, establish a strict, consistent, and relaxing routine: go to bed and wake up at the same time daily, even on weekends. Ensure your bedroom is cool, dark, and quiet. Avoid screens, alcohol, caffeine, and heavy meals 1–2 hours before bed, and limit naps to 20 minutes.

 

Sleep Associated Strengths

Quality sleep strengthens mental, physical, and emotional health by enhancing cognitive functions (memory, focus, problem-solving), accelerating physical recovery and muscle repair, strengthening the immune system, and improving emotional regulation and mood. Adequate sleep (7–9 hours) reduces risks of chronic illnesses like heart disease and injury, while increasing energy levels.

 

Too Dependent on CloZAPine?

Clozapine is a highly effective, often last-resort antipsychotic medication used for treatment-resistant schizophrenia, which has a distinct, strong sedative profile that profoundly impacts sleep. While it provides significant therapeutic benefits, its use is associated with high rates of dependency (both physical and psychological) and severe, sometimes persistent, sleep-related adverse effects.

 

Sleep Associated Strengths & Effects

Clozapine is known for its strong sleep-consolidating and sedative properties, with sedation occurring in 10% to 90% of patients.

 

Improved Sleep Continuity

It is associated with increased total sleep time (9.35 h/d on average) and reduced wake time after sleep onset.

 

Sleep Architecture Changes

Clozapine consistently increases Stage 2 non-REM (NREM) sleep (by up to 44%) and decreases Stage 4/slow-wave sleep.

 

REM Impact

While early studies showed inconsistent results, some research indicates a dramatic increase in REM sleep time at the expense of slow-wave sleep.

 

Slow-wave Sleep

Slow-wave sleep (SWS), or deep sleep, is the third stage of non-rapid eye movement (NREM) sleep characterized by slow, large-amplitude delta waves on an EEG. It is crucial for physical restoration, growth hormone secretion, memory consolidation, and brain metabolic cleaning. SWS dominates the first half of the night, with amounts decreasing with age.

 

Treatment of Insomnia

Clozapine is associated with significantly less insomnia compared to other antipsychotics (e.g., olanzapine, quetiapine, risperidone), acting as a potential therapeutic advantage for patients with comorbid severe insomnia.

 

Comorbid Severe Insomnia

Comorbid severe insomnia is a chronic condition where significant sleep disruption (difficulty falling/staying asleep, affecting daytime function) co-exists with, and often bidirectional with, psychiatric (depression, anxiety) or medical conditions (chronic pain, cardiovascular disease). Treatment should address both conditions simultaneously, rather than focusing solely on the underlying illness, to maximize success.

 

Dependency and "Too Dependent" on Clozapine

Clozapine dependency is a recognized clinical issue, often manifesting as severe withdrawal symptoms, rebound psychosis, or a psychological inability to cease treatment due to the high efficacy of the drug.

 

Withdrawal Symptoms

Abrupt cessation of clozapine can trigger withdrawal, including cholinergic rebound (characterized by cholinergic symptoms, such as sweating, salivation, diarrhea), which can lead to rapid relapse.

 

Physical Dependency

Physical dependency is a state resulting from chronic drug use where abrupt cessation causes withdrawal symptoms, with severity linked to dose and duration. While often associated with addiction, it can occur with therapeutic, long-term use of medications like opioids or benzodiazepines. Individual factors significantly influence the intensity of this condition.

 

Rebound Psychosis

A significant risk when trying to reduce or stop the medication, leading to a "dependency" where the patient cannot function without the drug.

 

Excessive Dependency (Over-reliance):

Studies show that 5.05% of clozapine-related adverse drug reactions were related to misuse, abuse, dependency, or withdrawal.

 

Persistent Sedation [Not Us]

"Too dependent" can also refer to the high prevalence of excessive daytime sleepiness (somnolence), which affects 36%–65% of patients. This can force patients to rely on the medication for sleep while suffering from chronic daytime tiredness.

 

Management of Dependency

 

Gradual Discontinuation

Withdrawal symptoms are closely associated with how quickly clozapine is stopped, necessitating a very slow, managed reduction in dosage to avoid severe relapse.

 

Pharmacokinetic Strategies [Only take it at night]

For extreme sleepiness or potential over-reliance on a high evening dose, doctors may use an "unbalanced split dose" (taking more at night) to manage daytime sedating effects.

 

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Treatment with clozapine must be managed by a psychiatrist.

 

High-dose CloZAPine Withdrawal: A Case Report and Timeline of a Single Potential Withdrawal Seizure

https://pmc.ncbi.nlm.nih.gov/articles/PMC6850498/ stop clozapine.

If the discontinuation of treatment with cloZAPine is desired, it should be gradually tapered off over several weeks (50mg/week), rather than abruptly discontinued. Slow off-titration is preferred, if possible, to avoid withdrawal syndromes.  Abrupt discontinuation has been reported in the literature to cause rebound psychosis, cholinergic rebound, serotonin syndrome, and catatonia. The discontinuation phenomena is thought to be related to cloZAPine’s short duration of action and its subsequent rapid dissociation from receptors.

 

What is a high dose of CloZAPine?

>We can’t remember the dosage of CloZAPine that Dr. Singh had us on back in 2006-2007 yet it was enough to make us pass out and fall at night when standing up to go to the bathroom.  Literature indicates that some people require up to 900 mg/day.  Ever since Dr. Lee re-established our Clozapine back in 2012 we have been on 200mg at bedtime.  In 2024 in collaboration Dr. Bera agreed to try 150mg per night.  If something could take the place of CloZAPine we would be willing to try it.

 

What is the typical dose of Clozapine per day?

Adults—At first, 12.5 milligrams (mg) per day, taken as a single dose or 2 times per day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 450 mg 2 times a day.

 

450 mg – Disabling

>If we were to take more than 200mg at night, it would disable us.  We wouldn’t be able to move or make it to the bathroom.  We would fall down and potentially hyper-flex one or both knees.  We know this from Lived Experience.

 

Hyperflexion

A hyperflexion knee injury occurs when the knee bends too far beyond its normal range of motion, often causing sharp pain, swelling, and damage to ligaments or cartilage, such as ACL ruptures and posterior meniscus tears. Common causes include falls, contact sports, and accidents, resulting in potential long-term instability.

Getting Up Too Early

>Since 2012, we have religiously begun our wind-down at 8pm with a half dose of CloZAPine.  At nine pm, we take the second half of Clozapine.  We usually fell asleep when the environment permitted it by 10pm.  If the environment permitted it we would sleep till 6am.  If we woke up before 3am we would take ½ our (1.0 mg) PRN Lorazepam.  Us getting up in the middle of the night and working with social media was a sign that something was wrong.

 

The wrong program! – For another time > Metadata >

01_Plan_Px_Early-Warning_14112504 V2026

 

How is it we experiment with our mental health management?

Experimenting with mental health management involves treating one's life as a research project, where individuals manipulate independent variables—such as lifestyle habits—and observe the impact on their mental state (dependent variable). This process, often called "n-of-1" experimentation or personal science, allows individuals to identify which strategies, routines, or tools improve their mood, reduce anxiety, and foster long-term wellness, personalized to their own biology.

 

We know and mutually agree to a medication (Trial)

A shared, mutual agreement on a medication—often referred to as concordance or shared decision-making—is a key component of effective, patient-centered care. It moves beyond mere compliance (taking orders) to a partnership where the patient and clinician agree on the treatment plan.

 

We don’t know anything about the new medication (Experiment)

>When the doctor unilaterally puts us on a new drug, and we have little knowledge of it or its’ actions, we call this an experiment.  Right off the bat, Haldol (1989) was an experiment gone wrong.  One day maybe doctors might take some of the drugs they prescribe. This would give them lived experience with adverse reactions and the like.  We once knew a parasitologist at UC Davis who lacked a stage in one of her life cycle collections, so she swallowed the infective stage of the parasite and collected up what she needed from her poop.

 Trial and Error with medication

Trial and error in medication, commonly used for mental health or chronic conditions, involves trying different drugs to find an effective one with manageable side effects. This process can be frustrating, often requiring patience to adjust dosages or switch medications. Pharmacogenetic testing can help guide choices by analyzing genetic factors, reducing the time to find the right treatment.

 

Ditto - Risk Issue: CloZAPine/Clozaril and CBC

Clozapine (Clozaril) carries a risk of severe neutropenia/agranulocytosis (critically low white blood cell count), necessitating mandatory Food and Drug Administration (.gov) FDA-mandated Absolute Neutrophil Count (ANC) monitoring via blood tests (CBC) to prevent fatal infections. Monitoring is highest (weekly) in the first 6 months, reducing to bi-weekly and then monthly if ANC remains normal.

 

20190403-W Crash Appointment

>Way back in 2019, we were investigating alternatives to CloZAPine.  We shared our notions with our psychiatrist, and he shut us down.  Because he had performed so well before, we call this our Crash Appointment.  Since we got out of skilled nursing on June 20, 2026, the doctor has changed the way he practices – he is more collaborative and user-friendly (rapport).

 

Why is a contingency plan with medications needed?

A contingency plan with medications is vital to ensure patient safety and continuity of care during unexpected disruptions, such as supply chain failures, natural disasters, or pharmacy outages. It prevents treatment interruptions for chronic conditions, secures medication access during emergencies, and ensures essential, time-sensitive medication remains available.

 

Gap in CloZAPine – Keith says

>In 2023, the doctor and I agreed to try something different than CloZAPine.  In late 2023 and early 2024, we tried about a half dozen medications.  I suffered a CloZAPine gap of my own making.  I primarily weathered the gaps in meds that were not of my making, such as errors in prescribing.  After a few gaps, I began setting aside backup medication.  The surplus was when  I was prescribed 30 days’ worth every 28 days.

 

What is perfect adherence?

Perfect adherence (≥100%) is the flawless execution of a prescribed healthcare plan, where a patient takes 100% of their medication at the exact correct time and dose, while also following all lifestyle recommendations, such as diet and exercise, for the entire duration. It means zero missed doses, ensuring optimal efficacy.

 

Adherence – Treatment Plan – Keith Says

I always took my CloZAPine in accordance with the prescribing doctor.  In 2022, I only required three medications: Lithium, CloZAPine, and Lorazepam (PRN).  The majority of the nights, I didn’t need Lorazepam.  Now that episode 2023-2024 is over, I’m prescribed six medications: Lithium, CloZAPine, Lorazepam (PRN), Ambien (PRN), Wellbutrin, and Ambilify. In a manner, my condition has worsened. The good news is that I am not overmedicated as I have been periodically in the past.

 

Role of Lorazepam

Lorazepam (Ativan) is a benzodiazepine that acts as a central nervous system depressant to treat anxiety disorders, insomnia, and acute seizures. It enhances GABA neurotransmitters to calm the brain, providing fast-acting sedation, reducing anxiety, and relaxing muscles. It is generally used for short-term treatment due to risks of dependence.

Hopes about Restoril

Restoril (temazepam) is a benzodiazepine designed for short-term insomnia treatment, aimed at reducing sleep latency (taking 15-30 minutes to work) and decreasing middle-of-the-night awakenings. Hopes include improved sleep quality and duration (7-8 hours) without severe morning grogginess or major disruption to restorative REM sleep.

 

Doctor Daniels’ 2012 Experiment – Keith Reports

>Dr. Daniel said she would do me better than any doctor before her, saying, “I’m going to put you in a place that you have never been”.  She immediately ended my CloZAPine, replaced it with a barbiturate for three nights, and injected me with a monthly injectable. [DITTO] After 3 nights not sleeping, Buster went to the hospital.  After experiencing and seeing Ted and Mikel not responding well to a monthly injectable, I’m not an avid supporter of monthly psychotropic injections.  This holds especially true when it comes to needing a Med in a cyclical fashion, such as CloZAPine at bedtime. 

 

Alternate Long Term Sleeping Medications

Long-term management of chronic insomnia often involves switching from habit-forming sedative-hypnotics to alternatives like dual orexin receptor antagonists (DORAs) such as Daridorexant (Quviviq) or Suvorexant (Belsomra). Other options include prescription sedating antidepressants (trazodone, doxepin) or natural supplements such as melatonin, valerian root, and magnesium to improve sleep quality without dependency.

 

Risks of a Mental Health Hospitalization

Mental health hospitalization carries risks including traumatic experiences, increased risk of suicide shortly after discharge, and potential psychological harm from coercive practices like involuntary restraint. Patients may experience heightened anxiety, stigma, loss of autonomy, and exposure to violence from others, making the environment sometimes counter-therapeutic, say studies on PMC9373183, PMC4011897, and the British Journal of Medical Practitioners.

 

Doctor Dobos’ Position on Tweaking PRN – Keith Says

>Circa 2000, I was working and going to school.  Dr. Dobos had a system that on Mondays and Fridays, we patients would gather at Kaiser Aliso Viejo for our medication management group.  At the beginning of a session, the nurse-group leader would gather all the information we patients had that we wished Dr. Dobos to consider.  She would leave and pass off her notes to Dr. Dobos.  He would vet the requests and at the end of the group, our nurse would return with his findings, including prescription revisions.  In this manner, Dr. Dobos made rapid changes to keep pace with my demands as a student.  Our treatment plans were driven by performance.  His working diagnosis for me at one point was Major Depressive Disorder.  I passed my classes with a 4.0 GPA.  Incidentally, my all-county GPA: Orange Coast College, Saddleback College, Cal State Fullerton, and Cypress College – is a 4.0. 

 

Is it helpful to share your grades?

>Online, they indicate: No, it is not good to share your grades.  Personally, I like to hear people's grades and the stories behind them.

Problems encountered (2012)

Gap in CloZAPine being prescribed and catastrophic losses

Separate Study > Metadata >

08_PEI_Catastrophic_Loss_16091002_Contents V2026

 

CloZAPine Contingency Experiment

>Can a combination of Melatonin and Lorazepam substitute for the sleep benefits of CloZAPine? This was investigated at Leisure Court (2024) when we were on Lorazepam and Restoril.  Leisure Court ran out of Restoril.  In the middle of the night, we asked for Melatonin.  They gave us Melatonin.  We did not sleep well.  On numerous occasions (7), Leisure Court either didn’t have Lorazepam or Restoril.  We stayed there 74 nights and, for the most part, did not sleep well.  In addition, the place is not peaceful at night with people yelling and screaming and the PA system loudly announcing a consumer in needs, room number.

 

Problem encountered (2023-24) – Gap in CloZAPine being prescribed

>We require CloZAPine to sleep.  This we confirmed when we agreed to try something to replace it back in 2023-2024.  Keith says: If I don’t get restful sleep, I get fatigued.  For me, over 72 hours of fatigue lands me in the hospital, and it may damage my brain.  In the event that my CBC (Neutrophils) is characterized as Agranulocytic, CloZAPine must be discontinued.  The following is a list of what helped me sleep in the past.

 

• Melatonin
• Benadryl
• Ambien
• Restoril
• Ativan (Lorazepam)
• Serzone

 

Serzone

Serzone (nefazodone) commonly causes drowsiness, sleepiness, or sedation as a side effect. Somnolence (sleepiness) is one of the most frequently reported adverse events, occurring in up to 28% of cases. It is advised to avoid driving or operating machinery until you know how the medication affects you.

 

Is Serzone still available?

The brand-name antidepressant Serzone (nefazodone) is no longer available in the U.S. and was withdrawn from the market in 2004 due to risks of liver damage. However, generic versions of the medication, known as nefazodone, remain available and can still be prescribed.

 

CloZAPine Quality

CloZAPine represents the "gold standard" for treatment-resistant schizophrenia (TRS) and suicide risk reduction, but its clinical utility is uniquely coupled with the need for extreme rigor in monitoring and due diligence in safety management. Because of its potential to cause life-threatening agranulocytosis, it is subject to strict regulatory requirements.

 

Aside – “CloZAPine” – Numbers 123 files in our database with some being duplicates

 

Work Done > Report Link

Complete Blood Count (CBC) Component of CloZAPine Management – By Keith Torkelson MS (Pathology)

http://clozapinerx4ecstasy.blogspot.com/2018/

Formatting Issues yet a Good Report - Sep 28, 2018

 

TheDAG - Digital Appointment – Development (Excerpt)

AnimaCules - Feb 9, 2015

Appointment Prep For: May 9, 2017

Last Update: 20170506-SAT: Inspired by “Sam I Am”

>” Sam I Am” is/was an economist, earned his degree at UC Los Angeles, and was a high performer in his program.  I, as a Prosumer (Prosuming), am preparing for my appointment with a Behavioral Health Professional (BHP-Psychiatrist).  I only get about five (5) minutes every three months, I have to plan my time wisely.  I have a thirty (30) some odd page External Quality Review (EQR) report that is in scope for my BHP to review.  This will not happen. 

 

Aside - We may be suffering what we call TrumpETOSIS.  Some of it is paranoia, and the rest is legitimate fear.  This would be new and not a preexisting condition.  I just have to hope for the best.  Back to Sam I Am. About three (3) months ago, I saw Sam I Am share photos of his wife with the BHP that I am seeing this upcoming Tuesday.  So I am updating my Digital Appointment effort after a significant hiatus with a few photos of my most significant other ever, Joan.

 

SAM I AM!

 

FYI - Work Done
Keith Torkelson - P3D - Died too Young - In Memory
May 2014 – AnimaCules - May 19, 2014
https://ktork46.blogspot.com/2014/05/the-dag-p3d-died-young-in-memory.html
 

White Blood Cells

White blood cells (leukocytes) are essential components of the immune system, produced in the bone marrow to defend the body against infections, bacteria, viruses, and foreign invaders. They circulate in the bloodstream and tissues, acting as the body's defense mechanism through phagocytosis and antibody production. A normal WBC count is essential, while abnormal levels can indicate infections or diseases.

Quality Review

What good comes from grading your doctors?

Grading doctors through reviews and ratings helps patients select high-quality care, increases provider accountability, and highlights clinicians with good communication skills. These ratings often improve transparency, enabling better, informed choices for future patients, while encouraging doctors to maintain high performance standards.

Seeing how your doctor treats other patients

Observing how a doctor treats other patients—such as demonstrating empathy, respect, and active listening—offers crucial insight into their standard of care. Red flags include dismissive behavior (medical gaslighting), ineffective treatments, or signs of unprofessional conduct. Ensure your provider upholds consistent, ethical standards for all patients.

 

Why do they say that doctors Practice?

Doctors "practice" medicine because it is a continuous, hands-on application of knowledge rather than a static skill. The term signifies that medicine is an evolving science, requiring professionals to constantly learn, adapt, and refine their skills throughout their careers to provide the best care, rather than achieving perfect, unchanging mastery.

 

Associated Study > Died Too Young > In House Metadata >

Pin3D_Who Died Young_13102502 V2026

 

Conclusion

>This report is a product of lived experience (LE).  The purpose of this work was to disseminate intelligence regarding our case while ferreting out fixes to some of our concerns.  This information is important for those who would benefit from situational awareness of our case.  Actually, it is multiple cases because each time we get a new doctor, it opens a new case.  It is very likely that more and more consumers are going to be prescribed CloZAPine now that the blood testing requirement has been lifted.  CloZAPine is highly effective in Keith’s case and will be for the next generation, requiring tweaking to their neurochemistry. This is a brief study, and we are satisfied that we made our points. Finally, we find it therapeutic (cathartic) to address our contingencies for CloZAPine. There is still more work to do.

 

Appendix 

Doctor Cipher – Specialists – Psychiatrists
QGM = Quick Grade Method
Not complete or in chronological order

##	Name	Initials	TX Grade QGM	2020 1123 (M) Grade Point	Reasoning & Treatment Preferences
00	Wardel	xxW	NA	NA	No treatment
01	Arnold P Deutsch	APD	A-	3.7	Educated about med management Treated us  like an equal
02	Bum Soo Lee (BND)	BSL	A-	3.7	Continuity & Flexibility & Nice Guy
03	Clayton Lon Chau	CLC	A-	3.7	Education and hope
04	Daniels	xxD	F	0.0	Associated with hospitalization
05	David Royce Chandler	DRC	D	1.0	Associated with hospitalization
06	David Dobos	DxD	A+	4.3	Excelled at situational awareness
07	Graham (*) and Dean	D&G	C	2.0	Never get better philosophy
08	Himasiri K De Silva	HKDS	D	1.0	Cookie Cutter
09	Ravinder P Singh	RPS	A+	4.3	Sized up medication history
10	Rimal B Bera (BND)	RBB	B	3.0	Had high expectations for him
11	Scott Lambert	SxL	B	3.0	Ineffective
12	Andrew Inglis	AxI	A	4.0	Plain old nice guy Taught us Mental  Status Exams (MSE’s)
13	Alan Vu	AxV	C+	2.3	Associated with hospitalization
14	Clayton Lon Chau	CLC	A-	3.7	Parity Check Extra Weight
	CALC			=39.7/14
	Overall Psychiatrist Score =			2.8	Close to a “C+” Average

Date Scored: 20201123-M: QGM = Quick Grade Method

For Annual Christmas Card Report (CCR)

Annual Christmas Report Card (CRC)