CLOZAPINE THERAPY FOR OLDER VETERANS

Objective: The effectiveness of clozapine treatment in a treatment-ref ractory) sample of older adult veterans Kith primary psychosis was exa mined. Methods: Data were collected over a five-year period for patien ts age 55 and older who were given clozapine because of a history of t reatment-refractory or treatment-intolerant psychosis. At initiation o f clozapine therapy baseline demographic, clinical, and psychopatholog y data were collected. At baseline and quarterly, patients' psychopath ology was rated with the Brief Psychiatric Rating Scale (BPRS), and in voluntary movements were rated with the Abnormal Involuntary Movement Scale (AIMS). Results: The 329 patients age 55 or older who received c lozapine during the study. period represented 10 percent of all patien ts on clozapine therapy in the VA system. Of the 312 patients for whom demographic information was available, 294 were men and 18 were women . Overall, patients improved on clozapine therapy, although nide varia tion in drug response was observed, Complete BPRS and AIMS data were a vailable for 97 patients, The 55- to 64-year-old group had a mean impr ovement in total BPRS score of 19.8 percent, with 42.6 percent showing more than a 20 percent improvement; those age 65 and older had a mean improvement of 5.7 percent, with 17.2 percent showing an improvement greater than 20 percent. The 97 patients with complete AIMS data showe d a mean improvement of 16.6 percent in total score. Conclusions: Cloz apine is an important therapeutic agent for older adults with treatmen t-refractory psychosis. Patients between the ages of 55 and 64 may hav e a better response than those age 65 and older.