Atypical (second generation) antipsychotic treatment response in very late-onset schizophrenia-like psychosis

Symptom amelioration in older patients with very late onset schizophrenia-like psychosis (VLOSLP) is often difficult, with limited psychotropic response reports yielding variable findings. Information about atypical (second generation) antipsychotic use in this population is scant.

A consecutive sample of geriatric psychiatry outpatients and inpatients with psychotic disorders were retrospectively identified over a 31-month period based on systematic information abstraction from an electronic medical record (e-record). After exclusion criteria were applied, 8/138 outpatients and 13/362 inpatients met inclusion criteria for VLOSLP and had been naturalistically treated with an atypical antipsychotic during hospitalization or nine months of outpatient care. Mandatorily completed e-record standardized symptom severity response ratings were converted into positive treatment response thresholds.

38% of outpatients and 77% of inpatients (mean age = 76 years for both groups; mean age of onset of psychosis = 70 years for outpatients and 74 years for inpatients) met criteria for positive treatment response to an atypical antipsychotic (either aripiprazole, olanzapine, quetiapine, or risperidone) with sign/symptom amelioration, rather than eradication.

Various atypical antipsychotics at geriatric doses yielded a positive treatment response in nearly two-thirds of VLOSLP patients. Patients with less chronic, more severe symptoms responded at a higher rate. Prospective, double-blind, placebo-controlled trials with representative subject samples are needed to validate these preliminary findings.