Better care · Schizophrenia
The diagnosis is rarely the hard part. The hard part is keeping the most effective treatment in place for years, catching relapse before it lands the patient in an emergency room, and protecting a life worth living around the illness. Sigmund stays present across that arc — not just the visit. This is part of how Sigmund moves beyond the scribe.
The clozapine paradox
Clozapine is the only antipsychotic with established superiority for treatment-resistant schizophrenia, and the only psychiatric medication shown in a randomized trial to reduce suicidal behavior — the InterSePT trial, where clozapine outperformed olanzapine in patients at high suicide risk. For the roughly one in three patients whose psychosis does not respond to two adequate antipsychotic trials, it is frequently the difference between a life inside the illness and a life outside it.
And it is profoundly underused. Eligible patients wait years, or never start. The reasons are not clinical equipoise — they are friction: the absolute neutrophil count monitoring cadence, the REMS paperwork, the prescriber hesitancy that compounds with every undocumented draw. The evidence is unambiguous. The delivery system fails it.
This is the exact problem the Sultan Lab has studied directly. Dr. Sultan's 2017 analysis in the Journal of Clinical Psychiatry evaluated the effect of the FDA's 2015 change to clozapine ANC monitoring thresholds — work that fed the national conversation on lowering the barriers to a treatment that saves lives. Sigmund operationalizes that conviction: make the monitoring burden disappear into the workflow, so the medication stays where the evidence says it belongs.
In the chart
The reason clozapine gets dropped is almost never that it stopped working. It is that the documentation tail outran the clinic. Sigmund holds that tail automatically:
Sigmund remembers where each patient sits in the schedule — weekly for the first six months, every two weeks to twelve, then monthly — flags the draw that is due or overdue, and writes the result into the note with the REMS-required language already in place.
The Clozapine REMS attestation, the dispense authorization logic, the documented rationale for continuing through a benign or transient neutropenia — surfaced and drafted in the note, not chased after hours.
Sialorrhea, constipation that can become ileus, sedation, weight and metabolic drift, myocarditis warning signs in the first weeks — the adverse-effect profile that frightens prescribers, surfaced for action and documented as the regimen is built.
Why this patient is on clozapine, what failed before it, the suicide-risk reduction it is carrying — the defensible reasoning a reviewer expects, written into the note so the decision never has to be reconstructed.
The documentation that deters prescribers becomes the documentation that protects them — generated from the encounter, not added to the evening.
Real-time ecological monitoring
Schizophrenia relapse rarely announces itself in clinic. It builds in the spaces between visits — sleep fragments first, activity falls off, social contact narrows, the day-night rhythm inverts — and by the time it reaches the appointment, or the emergency department, the prodrome is weeks old. A monthly fifteen-minute visit cannot see it.
Sigmund pairs with the PAWS wearable — a working wrist-worn companion on the Google Pixel Watch, built with Google and advancing through an NIDA UG3/UH3 award toward FDA clearance — to close that gap. Through it he watches the ecological signal continuously — sleep architecture, activity level, circadian regularity, social rhythm — and surfaces the early-relapse pattern to the clinician while there is still time to act: a dose conversation, an outreach call, a visit moved up. It captures medication-adherence patterns the same way, so a quiet thirty-day gap shows up as a signal, not as a readmission.
This is the difference between reacting to a crisis and preventing one. The clinician sees the trajectory, not just the snapshot — the longitudinal arc of the patient between the moments they are in the room.
What recovery actually measures
A falling symptom score is not the same as a life rebuilt. For schizophrenia, the outcomes that matter to patients and families — staying out of the hospital, holding a relationship, keeping housing and autonomy, finding meaning in a day — are precisely the ones that live in the arc between visits and slip out of a symptom-rating snapshot.
Because Sigmund holds the longitudinal record — the medication trial history, the side-effect profile by agent, the functional trajectory, the risk events — it lets the clinician treat the person across time, not the visit in isolation. The most effective medicine, kept in place. The relapse, caught early. The life around the illness, protected. That is what better schizophrenia care looks like, and it is what Sigmund is built to make routine.
The evidence base · clozapine in treatment-resistant schizophrenia
Sigmund is investigational and is intended to assist — not replace — clinical judgment. See the full better-care model, the architecture, and the scribe it is built on.
