MANAGEMENT OF LATE-LIFE PSYCHOSIS

Since the average lifespan is becoming longer, the number of older pat ients with psychoses is expected to increase. Late-life schizophrenia is prototypical of these chronic psychotic disorders. Antipsychotic dr ugs are the most effective symptomatic treatment. Pharmacotherapy in o lder patients, however, is complicated by alterations in pharmacokinet ics and pharmacodynamics. The risk of many adverse effects is consider ably higher in the elderly. For example, we found the cumulative annua l incidence of tardive dyskinesia among patients over age 45 to be 26% , which was five to six times greater than that reported in younger pa tients. Studies suggest that most patients with schizophrenia relapse without neuroleptic maintenance therapy, exemplifying the need for imp roved pharmacologic regimens. Data concerning the use of the newer ser otonin-dopamine antagonists in patients with late-life psychoses are l imited. Initial studies suggested that clozapine is efficacious, but i ts use is limited by side effects. Risperidone is also clinically bene ficial and is generally well tolerated, but needs to be prescribed in lower doses than those recommended for younger adults. Antipsychotic u se in the elderly should be accompanied by careful conservative dosing and close patient monitoring.