Supports patients living with psychosis who have not responded well to previous treatments.

Psychosis treatment optimization program (PTOP) is a community program that works with people whose medication is not working well to treat their psychotic illness.

These individuals often continue to have symptoms such as hearing voices, believing people are trying to hurt them, and/or having trouble thinking and communicating clearly even when on medication. These symptoms get in the way of the person's ability to have good relationships, to work or go to school.

About one-third of all individuals that have psychosis will not respond well to some antipsychotic medication. If a person does not respond well to two different antipsychotic medications, they are considered to be treatment resistant.

The first step in the program is for the individual to be assessed by our clinical team, consisting of nurses, psychiatrists, pharmacists, and a psychologist who work together with the individual to find new treatments that work better for them.

Once the assessment is complete, one of our psychiatrists will meet with the individual and recommend a treatment plan.


Treatment can include:

  • Treatment optimization
    Following an assessment, the psychiatrist may suggest other medications that may be helpful.
  • Clozapine monitoring
    One of the medications that may be suggested for individuals is clozapine. Clozapine is a very effective medication for treatment resistant psychosis. This medication comes with a number of side effects, some of which can be serious. One serious but rare, side effect can affect the body's ability to fight infections by lowering white blood cells. This side effect can be safely monitored with regular blood work and support from trained staff to closely monitor the individuals they work with. This service is available for as long as the individual is on clozapine. Common side effects may include drowsiness, low blood pressure, increased heart rate, weight gain, constipation and excessive drooling. These side effects can also be managed with the support of the individual’s care team.
  • Cognitive behavioural therapy (CBT) for psychosis
    Cognitive behavioural therapy (CBT) is a type of talk therapy where thoughts, feelings, and behaviours are explored. With psychosis, individuals may experience strange beliefs or may hear voices even while on medication. CBT targets these symptoms. Individuals will attend 15 to 20 weekly sessions with a trained CBT therapist.
  • Follow-up appointments
    Regular follow-up appointments will be scheduled to monitor the individual’s progress with their treatment. During this time the individual continues to be followed by his/her treatment team at the mental health and substance use centre in their community or their family doctor.



Referrals are made through your family doctor or your psychiatrist. You can ask your psychiatrist or family doctor to make a referral for you to the PTOP clinic in your community.