Global availability of clozapine and the risk of decompensation for recent geriatric patients from Africa: A case report

摘要

In individuals with schizophrenia resistant to other antipsychotics, the atypical antipsychotic, clozapine, has been found to be an effective treatment. However, the associated risk of agranulocytosis, routine testing and monitoring of the absolute neutrophil count (ANC) is required. We report a case of a chronically ill 70-year-old woman who migrated from Africa and had been successfully treated with clozapine while in her home country and then in the United States. A testament to the increased availability of state of the art treatment globally and challenges of migration in geriatric patients. She presented to the hospital, due to agitated behavior and noncompliance with medications. She had been on clozapine 150 mg daily for the past 4 years. In the past, she had tried several antipsychotics for multiple psychotic episodes but reported a poor response. Prior to moving to the United States about 9 months ago, she had been compliant with clozapine 150mg/day, and also had an extensive history of outpatient and inpatient treatment in her home country. The patient decompensated due to medication noncompliance. This case explores patient outcome if clozapine treatment is abruptly discontinued and subsequently reinstated with other antipsychotic medications as well as the factor of migration as a significant stressful event in the etiology of psychiatric disorders. Migrating to a new country can be challenging, especially for geriatric patients given acculturation challenges which may result in medication noncompliance. We recommend that geriatric patients be closely monitored during migration to minimize decompensation risks.