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. CASE SUMMARY: 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.