Atypical Antipsychotics in Elderly Patients with Dementia or Schizophrenia: Review of Recent Literature

Abstract

Atypical antipsychotics have become a common pharmacologic option for the treatment of various psychiatric and behavioral symptoms in older adults, although these medications have been officially approved by the U.S. Food and Drug Administration for use only in schizophrenia and bipolar disorder. Despite the widespread use of these agents, there is a relative shortage of rigorously conducted trials. This review focuses on recently published randomized, blinded, controlled trials involving the use of atypical antipsychotics in elderly patients with dementia (n = 9) or schizophrenia (n = 3), with some discussion of published large, open-label studies and a few unpublished controlled trials. In general, the studies of patients with dementia reported modest efficacy of atypical antipsychotics when compared to placebo and conventional antipsychotics. In addition, an advantage in terms of motor side effects was consistently noted with atypical antipsychotics when compared to conventional antipsychotics. The studies have also shown, however, a greater risk of mortality and adverse cerebrovascular events with several of these agents than with placebo in individuals with dementia. There are insufficient data comparing atypical antipsychotics to one another. In the trials involving elderly persons with schizophrenia, atypical antipsychotics were associated with significant improvements in psychopathology; differences in efficacy among atypical antipsychotics were unclear. A careful consideration of the risk-benefit ratio of atypical antipsychotics, as well as that of available alternative treatments, is needed for each individual elderly patient. Clinical judgment, caution, and consent should be the watchwords in this area of psychopharmacology.

Predictors of adherence to atypical antipsychotics (risperidone or olanzapine) in older patients with schizophrenia: an open study of 3½ years duration

“…The evidence base for the use of antipsychotics in older people with schizophrenia is small and generally of low quality (Arunpongpaisal et al, 2003;Jeste et al, 2005). The evidence that does exist though suggests that atypical antipsychotics may be of particular benefit in managing this patient group (Ritchie, 2005).…”

Long‐term safety and efficacy of long‐acting risperidone in elderly psychotic patients

“…Although antipsychotics are commonly used in elderly patients, there is a paucity of data regarding use of these medications in geriatric patients with schizophrenia (Jeste et al, 2005;Marriott et al, 2006). Most studies have evaluated elderly patients with dementia-related psychiatric illness, with few studies in geriatric patients with schizophrenia (Jeste et al, 2005).…”

“…Most studies have evaluated elderly patients with dementia-related psychiatric illness, with few studies in geriatric patients with schizophrenia (Jeste et al, 2005). Treating elderly patients with antipsychotics is complicated by concerns about treatment-limiting side effects.…”

“…These medications may be particularly beneficial in improving compliance in elderly patients, especially if memory impairment results in missing daily doses of oral medication (Masand and Gupta, 2003). Despite of the limited data on the treatment of psychotic illnesses, especially schizophrenia, in the elderly, atypical antipsychotics, including oral risperidone, are widely used in this population due to better tolerability compared with conventional antipsychotics and reduced risk for developing troublesome movement disorders (Barak et al, 2002;Jeste et al, 2005). Lasser et al (2004) performed a subgroup analysis of patients !65-years-old participating in a 12-month, open-label clinical trial converting patients with schizophrenia or schizoaffective disorder on a stable antipsychotic dosage to risperidone long-acting injectable (RLAI).…”

Envelhecer com Esquizofrenia

“…A própria utilização de anticolinérgicos para contrariar os efeitos extrapiramidais, só per si, também provoca efeitos colaterais importantes nas pessoas mais idosas como confusão e delírio. Numa revisão da literatura realizada por Jeste et al (2005) conclui-se que os antipsicóticos atípicos constituem o tratamento de escolha em idosos com demência ou esquizofrenia. No entanto, apela-se à precaução e avaliação de riscos-benefícios para a sua utilização.…”