A pilot study examining the profile of older people on clozapine.

OBJECTIVE:: The primary aim was to comprehensively describe the characteristics of a cohort of older people taking clozapine. METHOD:: Participants aged ⩾ 60 had a geriatric assessment including full medical, medication and social history. Standardized screening tools for cognition, function, comorbidity and antipsychotic side effects were administered and descriptive statistics utilized. RESULTS:: Thirteen patients were eligible to participate and 10 were assessed. The mean age was 69 years. The mean clozapine dose was 309 mg/day and mean duration of use was 10 years. All participants had executive dysfunction, and half had cognitive impairment. The mean number of co-morbid conditions was five. Seven people met the criteria for polypharmacy. Eight people experienced moderate-severe antipsychotic-related side-effects. The majority demonstrated impaired physical functioning. CONCLUSIONS:: This cohort of older people taking clozapine experienced considerable morbidity, functional and cognitive impairment. We suggest routine screening of cognition and function in clozapine patients aged ⩾ 60 years. Those screening positive should be considered for further assessment by Older Person's Mental Health Services and/or a Geriatric Medicine service.

The effect of comorbidity on quality of life during radiotherapy in head and neck cancer.

OBJECTIVE: To identify the impact of comorbidity on quality of life during radiotherapy in head and neck cancer patients. STUDY DESIGN: Prospective assessment of quality of life and retrospective assessment of comorbidity. SUBJECTS AND METHODS: Patients' quality of life was assessed at the start and twice during radiation treatment with the University of Washington Quality of Life questionnaire. Comorbidity was assessed from the case notes of 91 patients with the Adult Comorbidity Evaluation-27 index. RESULTS: A mean comorbidity burden of 1.07 was found. Comorbid illnesses afflicted a little more than 60 percent of our cohort. Patients with moderate to severe comorbidity had statistically significantly worse quality of life at the start (P = 0.044) and midpoint of treatment (P = 0.005), but not at the end of treatment (P = 0.114). The magnitude of change of these scores after treatment was not influenced by comorbidity. CONCLUSION: On the basis of severity of decompensation, radiotherapy does not produce a differential impact on the quality of life.

Electroconvulsive therapy clinics in the United Kingdom should routinely monitor electroencephalographic seizures.

Information recorded during electroconvulsive therapy for all patients treated in Central Manchester was analyzed to examine the range of seizure thresholds, the frequency of prolonged seizures, and the difference between the length of motor and electroencephalographic seizure activity. Prolonged seizures occurred in 19% of courses studied. EEG seizure length was significantly longer than observed motor seizure length. EEG monitoring will detect prolonged seizures and should be performed routinely in ECT clinics in the United Kingdom.