Treatment of obsessive-compulsive disorder using clomipramine in a very old patient.
OBJECTIVE
To describe the effect of the tricyclic drug clomipramine in a very old patient with obsessive-compulsive disorder and Alzheimer dementia.


METHODS
A 93-year-old woman had a history of obsessive-compulsive disorder since early adulthood. The obsession consisted of remembering names of famous people and the compulsion consisted of excessive list making. With the onset of memory loss secondary to Alzheimer disease, she became increasingly anxious and compulsive as a result of a failure to remember. After nine weeks on fluoxetine she became jittery and more confused. After a two-week wash-out period, she was given a nine-week course of clomipramine that was carefully titrated up to a therapeutic concentration.


RESULTS
At the completion of clomipramine treatment, the patient no longer felt driven to recall the names of famous people. Her score from the Yale-Brown Obsessive-Compulsive Scale dropped from 29 to 3. Her Folstein Mini-Mental State Examination score increased from 21 to 23.


CONCLUSIONS
Clomipramine appeared much more effective and better tolerated than fluoxetine in this very old patient despite its potential anticholinergic effect and the coexistence of Alzheimer disease.
Department of Psychiatry, State University of New York, Health Science Center at Brooklyn 11203, USA.
B
B
Trappler
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications*; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D002065:Buspirone / Q000627:therapeutic use; D002997:Clomipramine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D009771:Obsessive-Compulsive Disorder / Q000150:complications / Q000188:drug therapy*; D011569:Psychiatric Status Rating Scales; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use
D014151:Anti-Anxiety Agents; D000929:Antidepressive Agents, Tricyclic; D002065:Buspirone; D002997:Clomipramine; D005473:Fluoxetine; D017367:Selective Serotonin Reuptake Inhibitors