The efficacy and safety of clozapine versus chlorpromazine in geriatric schizophrenia

Background: There has been an absence of controlled studies focusing specif ically on neuroleptic treatment in the elderly schizophrenic population. Th erefore, we conducted a 12-week double-blind comparison study to assess the efficacy and tolerability of clozapine and chlorpromazine in a group of el derly inpatients with chronic schizophrenia. Method: Forty-two elderly DSM-IV schizophrenic veterans were randomly assig ned to clozapine or chlorpromazine and assessed for efficacy at baseline an d at termination with the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impressions scale (CGI). Side effects were also monitor ed. Medications were titrated, on the basis of clinical response and side e ffects, to a maximum dose of 300 mg/day of clozapine or 600 mg/day of chlor promazine. Results: The results suggest that both the chlorpromazine and clozapine gro ups improved their PANSS scores at termination compared with baseline, but the difference between the 2 groups was not statistically significant. The mean CGI scores reflecting severity of illness also demonstrated improvemen t in both groups over time. Both groups had similar incidences of side effe cts. One patient in each group had a life-threatening side effect. More pat ients taking clozapine had tachycardia and weight gain, while more chlorpro mazine patients noted sedation. Conclusion: We concluded that both clozapine and chlorpromazine are effecti ve treatments for psychosis and behavioral disturbances in geriatric schizo phrenia. Both agents had similar incidences of side effects. With careful m onitoring and titration of dosage, both clozapine and chlorpromazine were f airly well tolerated in this population.