The palliative role of clozapine in advanced Parkinson’s disease

<h3>Background</h3> In Parkinson’s Disease (PD), over half of the patients develop psychotic symptoms over the course of their disease (1). PD Psychosis is associated with an increased risk of nursing home admission, and mortality when compared to patients without psychosis (2). Clozapine is recommended by NICE as an antipsychotic that does not worsen motor symptoms for patients with PDP. <h3>Results</h3> In the South Tees Movement disorder service, we looked at 33 patients that have been prescribed clozapine from 2016 until November 2023. 19 patients had died since commencing clozapine, and 14 are still currently receiving the treatment. 79% of the patients who died, started clozapine within their last 2 years of life. Average treatment length of those who died on clozapine was 18.5 months, which is slightly lower than the average length of time on clozapine for all patients at 21 months. Seven patients stopped clozapine, all of whom had died at the time of data collection. <h3>Conclusion</h3> This data indicates that within the PD service, psychosis requiring clozapine prescription often occurs within the last 2 years of life. Clozapine has a role in symptomatic relief in these patients, hence effectively improving the quality of life of advanced PD and reducing caregiver strain.