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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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References

Aparasu, R. R., Jano, E., Johnson, M. L. and Chen, H. (2008). Hospitalization risk associated with typical and atypical antipsychotic use in community-dwelling elderly patients. American Journal of Geriatric Pharmacotherapy, 6, 198–204.Google Scholar
Barak, Y., Wittenberg, N., Naor, S., Kutzuk, D. and Weizman, A. (1999). Clozapine in elderly psychiatric patients: tolerability, safety, and efficacy. Comprehensive Psychiatry, 40, 320–325.Google Scholar
Chahine, L. M., Acar, D. and Chemali, Z. (2010). The elderly safety imperative and antipsychotic usage. Harvard Review of Psychiatry, 18, 158–172.Google Scholar
Czobor, P., Volavka, J. and Meibach, R. C. (1995). Effect of risperidone on hostility in schizophrenia. Journal of Clinical Psychopharmacology, 15, 243–249.CrossRefGoogle ScholarPubMed
Davidson, M. et al. (2000). A long-term, multicenter, open-label study of risperidone in elderly patients with psychosis. On behalf of the Risperidone Working Group. International Journal of Geriatric Psychiatry, 15, 506–514.Google Scholar
De Hert, M., Correll, C. U. and Cohen, D. (2010). Do antipsychotic medications reduce or increase mortality in schizophrenia? A critical appraisal of the FIN-11 study. Schizophrenia Research, 117, 68–74.CrossRefGoogle ScholarPubMed
Frankenburg, F.R. and Kalunian, D. (1994). Clozapine in the elderly. Journal of Geriatric Psychiatry and Neurology, 7, 129–132.Google Scholar
Gareri, P., De Fazio, P., Russo, E., Marigliano, N., De Fazio, S. and De Sarro, G. (2008). The safety of clozapine in the elderly. Expert Opinion Drug Safety, 7, 525–538.Google Scholar
Guenette, M. D. et al. (2013). Risk of neutropenia in a clozapine-treated elderly population. Schizophrenia Research, 148, 183–185.Google Scholar
Herst, L. and Powell, G. (1997). Is clozapine safe in the elderly? Australian and New Zealand Journal of Psychiatry, 31, 411–417.CrossRefGoogle ScholarPubMed
Howanitz, E. et al. (1999). The efficacy and safety of clozapine versus chlorpromazine in geriatric schizophrenia. Journal of Clinical Psychiatry, 60, 41–44.Google Scholar
Jääskeläinen, E. et al. (2013). A systematic review and meta-analysis of recovery in schizophrenia. Schizophrenia Bullettin, 39, 1296–1306.Google Scholar
Leucht, S. et al. (2013). Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis. Lancet, 382, 951–962.Google Scholar
Marriott, R. G., Neil, W. and Waddingham, S. (2006). Antipsychotic medication for elderly people with schizophrenia. Cochrane Database Systemic Reviews, 1, CD005580.Google Scholar
McEvoy, J. P. et al. (2006). Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment. American Journal of Psychiatry, 163, 600–610.Google Scholar
Meltzer, H. Y. (2012). Clozapine: balancing safety with superior antipsychotic efficacy. Clinical Schizophrenia and Related Psychoses, 6, 134–144.CrossRefGoogle ScholarPubMed
Sajatovic, M., Jaskiw, G., Konicki, P. E., Jurjus, G., Kwon, K. and Ramirez, L. F. (1997). Outcome of clozapine therapy for elderly patients with refractory primary psychosis. International Journal of Geriatric Psychiatry, 12, 553–558.3.0.CO;2-U>CrossRefGoogle ScholarPubMed
Stroup, T. S., Gerhard, T., Crystal, S., Huang, C. and Olfson, M. (2014). Geographic and clinical variation in clozapine use in the United States. Psychiatric Services, 65, 186–192.Google Scholar
Tiihonen, J. et al. (2009). 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). Lancet, 374, 620–627.Google Scholar
Wenthur, C. J. and Lindsley, C. W. (2013). Classics in chemical neuroscience: clozapine. ACS Chemical Neuroscience, 4, 1018–1025.Google Scholar