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Related Experiment Videos

Using antipsychotic agents in older patients.

George S Alexopoulos1, Joel Streim, Daniel Carpenter

  • 1Cornell Institute of Geriatric Psychiatry and Weill Medical College of Cornell University, USA.

The Journal of Clinical Psychiatry
|March 5, 2004
PubMed
Summary

Expert consensus provides guidance on antipsychotic use in older adults, recommending specific agents and durations for conditions like dementia and schizophrenia. These guidelines aim to aid clinical decision-making in geriatric psychiatry.

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Area of Science:

  • Geriatric Psychiatry
  • Psychopharmacology
  • Clinical Decision Support

Background:

  • Atypical antipsychotics offer expanded options for geriatric psychiatric disorders, yet clinical literature leaves many questions unanswered regarding their optimal use in older patients.
  • Expert opinion was surveyed to address critical aspects of antipsychotic therapy in individuals aged 65 and older, including indications, drug selection, dosing, and treatment duration.

Framework:

  • A comprehensive survey with 1,411 options was developed based on a literature review, utilizing a modified RAND 9-point scale for appropriateness ratings and open-ended questions for specific insights.
  • The survey was administered to 52 American experts in geriatric care, with 92% participation, ensuring a robust dataset for analysis.

Implementation:

  • Consensus was reached on 78% of rated options, establishing clear recommendations for various psychiatric conditions, including agitated dementia, late-life schizophrenia, delusional disorder, and psychotic mood disorders.

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  • Specific antipsychotics (e.g., risperidone, quetiapine, olanzapine) and dosing strategies were identified as first-line or second-line treatments for different indications.
  • Contraindications and cautious combination strategies were highlighted for patients with comorbid conditions (e.g., diabetes, cardiovascular issues) or those on concurrent medications.

    • Implications:

    • These expert-driven guidelines offer practical direction for managing complex clinical dilemmas in antipsychotic prescribing for elderly patients.
    • While expert opinion guides current practice, future research findings are expected to refine these recommendations, emphasizing the need for ongoing clinical judgment.