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Effectiveness and safety of clozapine in elderly patients with chronic resistant schizophrenia

Published online by Cambridge University Press:  28 August 2014

Shani Pridan ,
Marnina Swartz ,
Yehuda Baruch ,
Shelly Tadger ,
Igor Plopski  and
Yoram Barak
Shani Pridan
Affiliation:
Abarbanel Mental Health Center (affiliated with the Sackler Faculty of Medicine, Tel-Aviv University), Bat Yam 59100, Israel
Marnina Swartz
Affiliation:
Abarbanel Mental Health Center (affiliated with the Sackler Faculty of Medicine, Tel-Aviv University), Bat Yam 59100, Israel
Yehuda Baruch
Affiliation:
Abarbanel Mental Health Center (affiliated with the Sackler Faculty of Medicine, Tel-Aviv University), Bat Yam 59100, Israel
Shelly Tadger
Affiliation:
Abarbanel Mental Health Center (affiliated with the Sackler Faculty of Medicine, Tel-Aviv University), Bat Yam 59100, Israel
Igor Plopski
Affiliation:
Abarbanel Mental Health Center (affiliated with the Sackler Faculty of Medicine, Tel-Aviv University), Bat Yam 59100, Israel
Yoram Barak*
Affiliation:
Abarbanel Mental Health Center (affiliated with the Sackler Faculty of Medicine, Tel-Aviv University), Bat Yam 59100, Israel
*
Correspondence should be addressed to: Yoram Barak, MD, MHA, Director – Psychogeriatrics, Abarbanel Mental Health Center, 15 KKL Street, Bat Yam 59100, Israel. Phone/Fax: +972-3-5552738. Email: mdybarak@gmail.com.
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Abstract

Background:

Recommendations for the treatment of elderly schizophrenia patients are largely based on data extrapolated from studies of antipsychotic medications in younger patient populations. We aimed to evaluate the effectiveness and safety of clozapine monotherapy in a diagnostically homogeneous group of elderly patients suffering from schizophrenia (DSM-IV-TR criteria).

Methods:

A retrospective analysis of computerized medical charts of elderly inpatients suffering from schizophrenia treated at our center during the period January 2007–December 2012 was undertaken. Inclusion criteria were: (1) 60 years and older, (2) unsuccessful treatment with at least three different antipsychotic compounds during the last five years prior to the study period. Mortality and re-hospitalization over a five-year period were the pre-defined outcome measures.

Results:

Of 527 elderly patients suffering from schizophrenia 43 patients, mean age 69.4 ± 8.7 years, were treated with clozapine. There were 19 women and 24 men, mean disease duration was 38.8 years. All had been exposed to at least three first- and second-generation antipsychotics prior to clozapine treatment. Clozapine was very well tolerated by the patients and mortality rate (8/43 (18.6% vs. 87/484 (18%)) was equal to that of other first- and second-generation antipsychotics (p < 0.18). Re-hospitalization rates with clozapine were significantly lower than rates for the five-year period prior to exposure to clozapine (0.41 vs. 3.8; p < 0.001).

Conclusion:

The present study demonstrates that clozapine is efficacious and safe for the treatment of elderly schizophrenia patients. Prospective studies are needed to support these findings.

Keywords

antipsychoticspsychopharmacologyschizophrenia
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Issue 1 , January 2015 , pp. 131 - 134
Copyright
Copyright © International Psychogeriatric Association 2014 

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