Tolerability and effectiveness of atypical antipsychotics in male geriatric inpatients

Abstract

The atypical antipsychotics are gradually becoming the mainstay of treatment for psychosis in the elderly. The present study examines the effectiveness and tolerability of risperidone and olanzapine treatment in 34 matched male patients admitted to a VA Medical Center geriatric inpatient unit. The Positive and Negative Syndrome Scale for Schizophrenia (PANSS), the Cohen‐Mansfield Agitation Inventory (CMAI), the Rating Scale for Side‐Effects, the Extra‐Pyramidal Rating Scale, and the Mini‐Mental State Examination were administered at admission and discharge. T‐tests at admission and discharge across groups indicate that the patients as a whole were performing significantly better following their stay on the CMAI (t(30)=4.31, p=0.000), the GAF (t(31)=9.73, p=0.000), the PANSS total score (t(29)=3.82, p=0.001), and the positive symptom portion of the PANSS (t(28)=4.29, p=0.000). No significant differences were detected between the two groups with regard to length of hospitalization, or reduction in scores on the PANSS, or CMAI, however the daily cost of risperidone was 1/3 as much as olanzapine (p=0.00). The two treatments were comparable in the elderly men evaluated in this study. Copyright © 2001 John Wiley & Sons, Ltd.

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

“…The literature on risperidone for the treatment of schizophrenia and related disorders in elderly patients includes a case series, seven retrospective studies (four retrospective comparison studies) ( Table 4), six open-label studies, and one double-blind comparison trial [45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] (see Table 4). All published reports found a good-to-moderate response with risperidone.…”

“…In a retrospective comparison study of 34 elderly hospitalized patients receiving either risperidone (n=17) or olanzapine (n=17), Verma et al [50] found no differences between the two groups with regard to length of hospitalization or efficacy. The investigators noted that the daily cost of risperidone was one-third that of olanzapine.…”

“…Table 5 [67][68][69][70] shows selected studies of olanzapine in elderly patients with schizophrenia/schizoaffective disorder and Table 6 [48,50,53,71] shows comparison studies of risperidone and olanzapine in elderly patients. Solomons and Geiger [67] conducted a retrospective chart analysis of the efficacy and safety of olanzapine in 58 elderly patients (age range 60-99 years) who had previously failed to respond to other antipsychotic medications.…”

Evidence-Based Practices in Geriatric Mental Health Care

“…Clinical reviews have reported that older persons are more susceptible to adverse effects of conventional antipsychotics, including parkinsonian side effects and tardive dyskinesia (80)(81)(82). Recent research on the use of novel antipsychotics among older adults is largely limited to open-label uncontrolled studies (85)(86)(87)(88) and a small number of controlled trials (89,90). Overall, the reports and reviews suggest that atypical antipsychotics should be considered as firstline agents in the treatment of schizophrenia among older persons.…”

Antipsychotics in clinical practice: guidelines for safe and effective use

“…There is good evidence that atypical antipsychotics are at least as effective as classical antipsychotics but are associated with significantly fewer serious side-effects (Beasely, 1996;Bondolfi et al, 1996;Tollefson et al, 1997;Taylor, 1997;Thomas and Lewis, 1998;King, 1998;Fleischhacker, 1999;Hawkins et al, 1999;Brown et al, 1999;Verma et al, 2001). Although atypical antipsychotics in general have fewer side-effects, particularly EPSEs, they may be associated with a number of important side-effects, e.g.…”