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A systematic review of clozapine’s effectiveness for primary psychotic and bipolar disorders in older adults

Published online by Cambridge University Press:  22 February 2021

Melissa Renzenbrink  and
Anne Pamela Frances Wand Open the ORCID record for Anne Pamela Frances Wand [Opens in a new window]
Melissa Renzenbrink*
Affiliation:
Older Persons’ Mental Health Service, Concord Centre for Mental Health, Concord, Sydney, New South Wales, Australia
Anne Pamela Frances Wand
Affiliation:
Older Persons’ Mental Health Service, Concord Centre for Mental Health, Concord, Sydney, New South Wales, Australia Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Sydney, Australia School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
*
Correspondence should be addressed to: Melissa Renzenbrink, Jara Unit, Concord Centre for Mental Health, Hospital Rd, Concord, NSW, 2139, Australia. Phone + 61 297 678 940; Fax: + 61 297 678 944. Email: [email protected].
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Abstract

Objectives:

The primary aim was to systematically review the literature regarding the effectiveness of clozapine in reducing symptoms of primary psychotic and bipolar disorders in older adults. The secondary aim was to describe other reported patient and caregiver outcomes of clozapine treatment in older adults.

Design:

MEDLINE, Embase, PsychINFO, ProQuest, and PubMed databases were searched according to PRISMA guidelines for original empirical research examining the effectiveness of clozapine in adults aged 65 years or more with primary psychotic and bipolar disorders. Identified studies were assessed for methodological quality using the QualSyst tool.

Results:

1121 records were screened, of which 7 studies met the inclusion criteria. In total, 128 subjects participated in the included studies (111 of whom were from a single study), with an age range of 65–86 years, and diagnoses including schizophrenia, schizoaffective disorder, bipolar disorder, and delusional disorder. Indications for clozapine use included treatment resistance and inability to tolerate other treatments. While six out of seven studies reported some improvement on the primary measure of psychopathology after treatment with clozapine, the group effects were modest and based on low-level evidence. Additional reported outcomes included discharge destination, death, and relapse. Most of the included studies were only of adequate methodological quality, with significant risks of bias identified.

Conclusions:

Clozapine may have positive effects for primary psychotic and bipolar illnesses in some older adults, but the group effects reported were modest and based on low-level evidence studies with methodological limitations. Based on these findings, clinical decision-making about whether or not to trial clozapine should involve an individualized analysis of potential benefits and risks in collaboration with patients and their families and caregivers.

Keywords

delusional disorderefficacyoutcomespsychosisschizophreniaschizoaffective disorder
Type
Review Article
Information
International Psychogeriatrics , Volume 34 , Special Issue 10: Issue Theme: Pharmacotherapy for Serious Neuropsychiatric Disorders , October 2022 , pp. 875 - 887
Copyright
© International Psychogeriatric Association 2021

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