OUTCOME OF CLOZAPINE THERAPY FOR ELDERLY PATIENTS WITH REFRACTORY PRIMARY PSYCHOSIS MARTHA SAJATOVIC 1 *, GEORGE JASKIW 1 , P. ERIC KONICKI 1 , GEORGE JURJUS 1 , KONG KWON 2 AND LUIS F. RAMIREZ 3 1 Cleveland VA Medical Center, Assistant Professor, Case Western Reserve University, USA 2 Cleveland VA Medical Center, Assistant Clinical Professor, Case Western Reserve University, USA 3 Cleveland VA Medical Center, Associate Professor, Case Western Reserve University, USA ABSTRACT Objective. The objective was to analyze outcome of clozapine therapy in 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. Setting. A psychiatry service at a large urban/suburban Veterans Administration 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 patients met study inclusion criteria out of a total of 134 patients receiving clozapine at the Cleveland VAMC (7.5%). Mean age of the group was 70.6 years. Measures. Patients were rated with the Brief Psychiatric Rating Scale (BPRS; Overall and Gorham, 1962). Additional data on patient demographics, comorbid non-psychiatric diagnoses and concurrent psychotropic medi- cation were collected via chart review. Results. Mean clozapine dosage was 204 mg/day for a mean duration of 430 days. 7/10 patients had some degree of clinical improvement and 3/10 patients had signi®cant improvement documented by BPRS change of 20% or greater. Patients had a mean of 1.4 comorbid physical illnesses, which were not worsened by clozapine therapy. 4/10 patients discontinued clozapine therapy due to adverse eects or inability to comply with bloodwork; however, 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 tolerate drug-related adverse eects or weekly bloodwork may lead to drug discontinuation. # 1997 by John Wiley & Sons, Ltd. Int. J. Geriat. Psychiatry, 12, 553±558 (1997) No. of Figures: 0. No. of Tables: 1. No. of References: 28. KEY WORDS Ðelderly; geriatric; clozapine; schizophrenia; treatment refractory Schizophrenia aects approximately 1% of the elderly population (Gurland and Cross, 1982). Thirty-®ve per cent of the elderly who are hospital- ized in public psychiatric facilities, and up to 12% of nursing home residents, have schizophrenia or primary psychotic disorders (Gurland and Cross, 1982; Tariot et al., 1993). As lower birthrates and increased life expectancy continue, the proportion of elderly in the United States will grow signi®- cantly. Currently, one in every eight Americans is over 65, but by 2030 one in every ®ve Americans will be over age 65 (Malmgren, 1994). The number of elderly individuals with schizophrenia and other primary psychotic conditions may thus be expected to increase. As with younger patients, older schizophrenic patients generally improve with antipsychotic therapy (Jeste et al., 1993). However, therapeutic approaches to the elderly must take into account age-associated changes in physiology, development of comorbid medical illness and altered response to *Correspondence to: Dr M. Sajatovic, Cleveland VA Medical Center, Department of Psychiatry, 10000 Brecksville Road, Brecksville, Ohio 44141, USA. Tel: (216) 526±3030, Ext. 6830. Fax: (216) 546±2713. CCC 0885±6230/97/050553±06$17.50 Received 4 April 1996 # 1997 by John Wiley & Sons, Ltd. Accepted 3 July 1996 INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, VOL. 12: 553±558 (1997)