Treatment of elderly institutionalized bipolar patients with clozapine

In an open trial, clozapine was used to treat 3 elderly (mean age 72 +/- 2.5 years) institutionalized male patients with bipolar I disorder, most recent episode manic, severe with psychotic features. All patients were refractory or intolerant of treatment with lithium, valproate, benzodiazepines, and traditional neuroleptics both alone and in combination. Response to clozapine was determined using the Severity of Illness score on the Clinical Global Impression (CGI) scale (1 = normal, not at all ill, 7 = among the most extremely ill). Pre-clozapine severity of illness scores on the CGI averaged 6.33 +/- 0.6; post-clozapine CGI scores averaged 2.0 +/- 1.0 (t = 13.00, df = 2, p < .01). The therapeutic dosage of clozapine varied (range = 25-112.5 mg/day). There were no significant drops in granulocyte counts. Followup revealed sustained improvement over an average of 11 months. These dramatic results suggest that clozapine may be an effective alternative treatment for similar patients and that prospective trials are warranted.