Long-term outcome of clozapine use for psychosis in parkinsonian patients

A retrospective analysis was carried out on 39 parkinsonian patients on clozapine treatment greater than or equal to24 months for psychosis. The cohort had a mean age of 76 years and an average clozapine dose of 47 mg/day over 60 months of clozapine use. Of 39 patients, 13 (33%) patients were eventually admitted to nursing homes, 6 (46%) of whom died over a period of 5 years. The overall 5-year mortality rate in this cohort was 44% (17/39). Of 39 patients, 33 (85%) had continued partial/good response and 5 (13%) had complete resolution of psychosis. None discontinued clozapine due to motor worsening. Among patients who responded early on, the long-term efficacy of clozapine for psychosis was sustained. The risk of nursing home placement and mortality among parkinsonian patients treated with clozapine for psychosis in this geriatric cohort was better than that reported previously. Our data are more consistent with recently published long-term outcome data suggesting an improvement in the prognosis of parkinsonian patients with psychosis with the use of atypical antipsychotic agents such as clozapine. (C) 2004 Movement Disorder Society.