OUTCOME OF CLOZAPINE THERAPY FOR ELDERLY PATIENTS WITH REFRACTORY PRIMARY PSYCHOSIS

Objective. The objective was to analyze outcome of clozapine therapy i n elderly patients with treatment refractory primary psychosis. Design . This was an open-label clozapine trial in elderly patients. Patient psychopathology was assessed before and after clozapine therapy. Setti ng. A psychiatry service at a large urban/suburban Veterans Administra tion Medical Center. Patients. Inpatients and outpatients age 65 years or older with primary psychotic disorders established to be resistant to conventional antipsychotic therapy (Kane et al., 1988). Ten patien ts met study inclusion criteria out of a total of 134 patients receivi ng clozapine at the Cleveland VAMC (7.5%). Mean age of the group was 7 0.6 years. Measures. Patients were rated with the Brief Psychiatric Ra ting Scale (BPRS; Overall and Gorham, 1962). Additional data on patien t demographics, comorbid non-psychiatric diagnoses and concurrent psyc hotropic medication were collected via chart review. Results. Mean clo zapine dosage was 204 mg/day for a mean duration of 430 days. 7/10 pat ients had some degree of clinical improvement and 3/10 patients had si gnificant improvement documented by BPRS change of 20% or greater. Pat ients had a mean of 1.4 comorbid physical illnesses, which were not wo rsened by clozapine therapy. 4/10 patients discontinued clozapine ther apy due to adverse effects or inability to comply with bloodwork; howe ver, only 2/10 were truly treatment intolerant. Conclusions. Clozapine is a useful alternative treatment option for elderly individuals with refractory primary psychosis. As in younger patients, inability to to lerate drug-related adverse effects or weekly bloodwork may lead to dr ug discontinuation. (C) 1997 by John Wiley & Sons, Ltd.