The Role of Atypical Antipsychotic Agents in the Treatment of Schizophrenia and Schizoaffective Disorders in the Elderly

Abstract

Schizophrenia and schizoaffective disorder are prevalent in 1% of the adult population. The condition was thought to predominantly affect the young however recent studies have shown that the condition occurs in individuals throughout the life-span. The aim of this review is to discuss the role of atypical antipsychotics in treating schizoaffective disorder and schizophrenia in the elderly. The advent of atypical antipsychotics has made significant strides in the pharmacotherapy of schizophrenia in the elderly. They are as efficacious as conventional agents in reducing the positive symptoms, possibly some what more efficacious in reducing negative symptoms and appear to have a relatively safer adverse effect profile. However metabolic side affects particularly glucose abnormalities and weight gain, cerebrovascular effects, and mortality risk noted in dementia patients are gaining increasing attention. Appropriate monitoring for the metabolic side effects has been recommended by agencies such as the FDA (United States Food and Drug Administration), ADA (American Diabetic Association) and APA (American Psychiatric Association). Treatment of elderly patients is complicated by age related biological factors affecting drug response and presence of comorbid medical conditions and concomitant medication. Current research supports the role of atypical antipsychotics in the treatment of schizophrenia and schizoaffective disorder in the elderly. Despite advantages compared with conventional agents, challenges to successful therapy remain, even with these better tolerated agents.

The Elderly Safety Imperative and Antipsychotic Usage

“…69 Any psychotropic medications should be started in low doses and titrated slowly to the lowest effective dose. In patients with dementia, treatment with antipsychotics increases mortality throughout the duration of treatment.…”

“…25 Sedation occurred in signifi-cantly more patients treated with an atypical antipsychotic compared to placebo. Sedation is a relatively common side effect of antipsychotics in older adults; 69 it is most commonly reported as an adverse effect in trials of quetiapine in that age group, 27,48 though the risk is not greater than with treatment with haloperidol. 27 Some of the more common or more concerning adverse events associated with antipsychotic use are elaborated below.…”